Critical Care Manual of Clinical Procedures and Competencies E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1474

Veröffentlichungsjahr: 2013

Beschreibung

This manual is aimed at all healthcare practitioners, from novice to expert, who care for the critically ill patient, recognising that different disciplines contribute to the provision of effective care and that essential knowledge and skills are shared by all practitioners. It provides evidence-based guidelines on core critical care procedures and includes a comprehensive competency framework and specific competencies to enable practitioners to assess their abilities and expertise. Each chapter provides a comprehensive overview, beginning with basic principles and progressing to more complex ideas, to support practitioners to develop their knowledge, skills and competencies in critical care.

Leseprobe

Table of Contents

Title page

Copyright page

List of contributors

Foreword

Foreword

Preface

List of abbreviations

Chapter 1: Scope and delivery of evidence-based care

Chapter 2: Competency-based practice

Chapter 3: Recognizing and managing the critically ill and ‘at risk’ patient on a ward

Rapid response systems

Assessing and managing the deteriorating patient

Summary

Chapter 4: Admitting a critically ill patient

Admission of a patient to a level 2 or 3 care facility

Chapter 5: Assessment, monitoring and interventions for the respiratory system

CLINICAL ASSESSMENT

Chest auscultation

Arterial blood gas sampling

Pulse oximetry

Airway management and care with adjunct airways

MONITORING AIRWAY ADJUNCTS

Partial pressure of end tidal carbon dioxide (ETCO) monitoring

Measuring endotracheal/tracheostomy tube cuff pressure

INTERVENTIONS FOR THE RESPIRATORY SYSTEM

Ventilatory support

Non-invasive ventilation

Invasive ventilation

Weaning from mechanical ventilation

Other respiratory interventions

Intermittent positive pressure breathing (IPPB, e.g. Bird, Bennett PR2)

Suctioning via a tracheal tube (endotracheal or tracheostomy)

Humidification

Manual hyperinflation and hyperoxygenation

Prone ventilation

Chest drains

Flexible fibreoptic bronchoscopy

Summary

Chapter 6: Monitoring of the cardiovascular system: insertion and assessment

Electrocardiogram monitoring

Arterial blood pressure monitoring

Non-invasive arterial blood pressure monitoring

Invasive arterial blood pressure monitoring

Central venous pressure monitoring

Advanced haemodynamic monitoring

Haemodynamic monitoring

Summary

Chapter 7: Titration of inotropes and vasopressors

Choice of inotrope or vasopressor

Components of titration of inotropic drug therapies

Chapter 8: Assessment and support of hydration and nutrition status and care

Optimizing hydration and nutrition

Therapy

Problems with providing hydration and nutrition

Enteral feeding access in an intubated patient

Parenteral nutrition

Ethical considerations

Chapter 9: Continuous renal replacement therapies: assessment, monitoring and care

How CRRT works

Assessment and monitoring of the patient on CRRT

Chapter 10: Assessment and monitoring of analgesia, sedation, delirium and neuromuscular blockade levels and care

Pain

Sedation

Delirium

Neuromuscular blockade

Treatment

Chapter 11: Assessment and monitoring of neurological status

Assessment of neurological status

Invasive monitoring

Chapter 12: Assessment and care of tissue viability, and mouth and eye hygiene needs

Tissue viability

Pressure ulcers

Mouth care

Eye care

Chapter 13: Assessment of sleep and sleep promotion

Assessment of sleep

Factors that disrupt and promote sleep

Chapter 14: Physical mobility and exercise interventions for critically ill patients

Review of components of physical mobility and exercise

Interventions

Chapter 15: Transfer of the critically ill patient

Physiological effects of transfer

Evidence and current debates

Components of the transfer process

Competency statements

Guidelines for transfer

Chapter 16: Rehabilitation from critical illness

Review of components of rehabilitation from critical care

Rehabilitation interventions

Summary

Chapter 17: Withdrawal of treatment and end of life care for the critically ill patient

Pre-EOLC considerations: at the beginning

Prognosis

Post prognosis: EOLC in critical care environments

Care around withdrawal: care in the last days and hours

Consultation and communication of decision to withdraw treatment with patient, next of kin and significant others

Communication and breaking bad news: supporting the family

Cultural issues

Review of practical components of withdrawal of treatment and end of life care

Brainstem function measurement and death

After-death care

Competencies

Conclusion

Chapter 18: Cardiopulmonary resuscitation

Evidence for guidelines

In-hospital resuscitation

Initial management of the ‘collapsed’ patient

Index

This edition first published 2013

© 2013 by John Wiley & Sons, Ltd.

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Library of Congress Cataloging-in-Publication Data

Critical care manual of clinical procedures and competencies / edited by Jane Mallett, John W. Albarran, Annette Richardson.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-4051-2252-8 (pbk. : alk. paper)

I. Mallett, Jane, RGN. II. Albarran, John W. III. Richardson, Annette.

[DNLM: 1. Critical Care. 2. Critical Illness–therapy. 3. Monitoring, Physiologic. 4. Needs Assessment. WX 218]

616.02'8–dc23

2012044642

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image courtesy of the Editors

Cover design by Andy Meaden

List of contributors

John W. Albarran RN, DipN (Lon), BSc (Hons), PGDipEd, MSc, DPhil

Associate Professor in Cardiovascular Critical Care Nursing

Associate Head of Department for Research and Knowledge Exchange (Nursing and Midwifery)

Programme Manager for Doctorate in Health and Social Care

University of the West of England, Bristol

Micheala Allsop RN Dip, BSc (Hons)

Critical Care Research Nurse

Newcastle upon Tyne Hospitals NHS Foundation Trust

Andrew Baker MB, ChB, FRCA

Specialty Registrar, Anaesthesia and Critical Care

St James’s University Hospital, Leeds

Pauline Beldon RN, PGDip

Tissue Viability Nurse Consultant

Epsom and St Helier University Hospitals NHS Trust

Elaine Coghill BSc (Hons), PGDipEd, MSc

Quality and Effectiveness Lead

Newcastle upon Tyne Hospitals NHS Foundation Trust

Sarah Conolly MB, BS, FRCA

Consultant in Anaesthesia and Intensive Care Medicine

James Cook University Hospital, Middlesbrough

Maureen Coombs RN, PhD, MBE

Professor of Clinical Nursing (Critical Care)

Graduate School of Nursing Midwifery and Health Victoria University Wellington and Capital and Coast District Health Board, Wellington, New Zealand

Margaret A. Douglas RN, BSc (Hons), PGDip, MEd

Senior Lecturer

Northumbria University, Newcastle upon Tyne

Judy Dyos RN, PGDip, MSc

Lead Nurse Critical Care Education

University Hospital Southampton NHS Foundation Trust

Judy Elliott RN, BSc (Hons), MSc

Tissue Viability Nurse

East Kent Hospitals University NHS Foundation Trust

Vanessa Gibson RN, RNT, CertEd, PGDip, AdDip, MSc

Teaching Fellow and Principal Lecturer Critical Care

Northumbria University, Newcastle upon Tyne

Professional Advisor, National Board British Association of Critical Care Nurses

Karen Hill RN, BSc (Hons), MSc

Acuity Practice Development Matron

University Hospital Southampton NHS Foundation Trust

Lecturer in Critical Care Nursing

Southampton University

National Secretary, British Association of Critical Care Nurses

Christina Jones MPhil, PhD, CSci, MBACP, DHip

Nurse Consultant Critical Care Rehabilitation and Honorary Reader

Whiston Hospital, Liverpool

Institute of Ageing and Chronic Disease, University of Liverpool

Phil Laws MA, MRCP, FRCA, DipICM, EDIC, DipClinEd, FFICM

Consultant in Intensive Care Medicine and Anaesthesia

Newcastle upon Tyne Hospitals NHS Foundation Trust

Jane Mallett RN, BSc (Hons), MSc, PhD

Consultant in Health Care Development

Dorset

D.J. McWilliams BSc (Hons)

Clinical Specialist Physiotherapist – Critical Care

University Hospitals Birmingham NHS Foundation Trust

Ian Nesbitt MBBS, FRCA, DICM, FFICM

Consultant in Anaesthesia and Critical Care

Freeman Hospital, Newcastle upon Tyne

Mandy Odell RN, PGDip, MA, PhD

Nurse Consultant, Critical Care

The Royal Berkshire NHS Foundation Trust, Reading

Natalie A. Pattison RN, BSc (Hons), MSc, DNSc

Senior Clinical Nursing Research Fellow

The Royal Marsden NHS Foundation Trust

Alan T. Platt RN, BSc (Hons), PGDipEd, MSc

Senior Lecturer

Northumbria University, Newcastle upon Tyne

Sarah E.C. Platt MBBS, FRCA, DICM, FFICM

Consultant in Anaesthesia and Intensive Care

Royal Victoria Infirmary, Newcastle upon Tyne

Catherine I. Plowright RN, BSc, MSc, MA

Consultant Nurse Critical Care

Medway NHS Foundation Trust

Honorary Lecturer

Canterbury Christ Church University

Annette Richardson RN, BSc (Hons), MBA

Nurse Consultant Critical Care

Newcastle upon Tyne Hospitals NHS Foundation Trust

Jo Richmond RN, BSc

Corporate Nurse

Heart of England Foundation Trust

Jonathan Round MB, BS, FRCA

Specialty Registrar in Anaesthetics

Northern Deanery

Nicola Rudall BPharm (Hons), MSc, MRPharmS

Senior Lead Clinical Pharmacist, Perioperative and Critical Care

Newcastle upon Tyne Hospitals NHS Foundation Trust

Kirsty Rutledge RN, BSc (Hons)

Sister, Critical Care

Newcastle upon Tyne Hospitals NHS Foundation Trust

Julie Scholes RN, DipN, DANS, MSc, DPhil

Professor of Nursing, Director of Post Graduate Studies, Brighton Doctoral College

University of Brighton

Jasmeet Soar MA, MB, BChir, FRCA, FFICM

Consultant in Anaesthesia and Intensive Care Medicine

Southmead Hospital, Bristol

Amanda Thomas BAppSc(Phy), MAppSc(Ex&SpSc), MCSP, MACPRC

Clinical Specialist Physiotherapist

The Royal London Hospital

David Waters RN, PGDip, BA (Hons)

Senior Lecturer in Critical Care

Buckinghamshire New University, Uxbridge

Jayne Whatmore RN, Dip Health Studies

Sister, Critical Care

Newcastle upon Tyne Hospitals NHS Foundation Trust

Simon M. Whiteley MA, FRCA, FFICM

Consultant in Anaesthesia and Intensive Care

Leeds Teaching Hospitals NHS Trust

Philip Woodrow MA, RN, DipN, PGCE, MA

Practice Development Nurse, Critical Care

East Kent Hospitals University NHS Foundation Trust

Jackie S. Younker RN, PGCertEd, MSN

Senior Lecturer in Nursing

University of the West of England, Bristol

Foreword

In the last 15 years the majority of medical disciplines have adopted competency-based training as the standard approach to education. Nursing programmes were well in advance of doctors in this respect, having recognised for a long time the need to define professional practice (and hence the practitioners) in terms of knowledge, skills, attitudes and behaviours. This approach has been a powerful tool for creating a ‘product specification’ for clinicians whose abilities can so profoundly alter their patients’ lives. Moreover, competencies make clear those elements which are unique to a particular discipline, and those which are shared between disciplines. There are few specialties in which shared and complementary competencies are more important for teamworking than intensive care medicine, and this has been given visible expression through the European CoBaTrICE competencies which have been adopted by both the ICM physician programme and Advanced Critical Care practitioners in the UK.

Critical Care Manual of Clinical Procedures and Competencies takes this work forward by linking competencies to their underlying rationale and to the evidence required to demonstrate their acquisition, contained within the frame­work of an accessible textbook. This is a valuable method of linking knowledge acquisition to reflective learning in the workplace.

Competence alone is not enough however, particularly in the complex and fast-changing world of critical care. New scientific knowledge converted into best practice guidelines may stand the test of time or may be found to be wrong as further research evidence accumulates. The competent practitioner must therefore also be a critical and questioning professional. The first two chapters of this Manual very properly discuss the nature of evidence in practice, and how research evidence and practice experience should be integrated. If this Manual succeeds in fostering both competence and critical capacity it will have done much to improve patient care.

Julian Bion

Professor of Intensive Care Medicine

University of Birmingham

Birmingham, UK

Foreword

‘See one, do one, teach one’ as a means of passing on clinical skills and abilities from one generation to the next may sound fine in principle and indeed served the professions well for many centuries. However, in our modern world such simple concepts in the learning process have, by necessity, become much more complex.

Critically ill patients (and their families) expect and deserve competent, skilled and professional care, anything less can and will kill them. It has been unacceptable for some decades now to allow anything but skilled and qualified nurses care for critically ill patients in health facilities even in the poorest of countries.

In the UK, there are 60 million people, of whom 1% are nurses (600,000), and of this number approximately 5% are critical care nurses (30,000) caring for about 6000 critically ill patients at any given time. If we assume that the chances of a clinician failing to follow a standardized clinical procedure resulted in serious harm or death had a probability of one in a thousand cases on any given day, then six critically ill patients will be seriously harmed or killed by such failings today in the UK! The risk of error, harm and death for critically ill patients is very real and very present and the potential for such harm to occur on any given day will be escalated when staff are poorly skilled and do not follow standardized, evidence based clinical procedures and care. We have a profound and humbling duty as nurses and clinicians to ensure only correct protocols and procedures of care and treatment are followed.

Critical Care Manual of Clinical Procedures and Competencies is a detailed, thoughtful and necessary resource to inform nurses and clinicians of the correct procedure to follow when caring for the critically ill patient and their family. Evidence based, practical procedures and competencies are described in sufficient detail to assist the practising clinician to understand and apply their skills safely.

Edited by critical care nursing and practice development leaders, and informed by dozens of respected experts in their respective specialties, Critical Care Manual of Clinical Procedures and Competencies sets a necessary standard for the delivery of safe and effective care in the field of critical care. It is an essential reference for all who lead, teach and practise in critical care.

Ged Williams

Executive Director of Nursing & Midwifery, Gold Coast Hospitals & Health Service

Professor of Nursing, Griffith University, Gold Coast

Founding Chair/Past President, World Federation of Critical Care Nurses

Former Director, World Federation of Societies of Intensive Care and Critical Care Medicine

Founding President, Australian College of Critical Care Nurses

Preface

Background

The inspiration for the Critical Care Manual of Clinical Procedures and Competencies goes back many years. I edited three editions of The Royal Marsden Hospital Manual for Clinical Nursing Procedures (RMH Manual) (1992, 1996 and 2000) and was overwhelmed by the response of professionals to a text that brought together a set of evidence-based procedures concerning cancer care. The RMH Manual was (and still is) viewed as an essential text and a ‘bible’ for nursing. The Critical Care Manual of Clinical Procedures and Competencies (Critical Care Manual) has developed from this tradition.

Vision and purpose

The Critical Care Manual aims to support optimum treatment and care for patients who are critically ill. In order to develop evidence-based procedures and the elements of com­petency required for each area, an open-minded approach has been utilised to consider whether there is enough evidence to support new specific clinical interventions and to challenge, as appropriate, current methods. This has involved rigorous examination of research findings, expert clinical consensus and existing practice by international experts. Hopefully, the result is a Critical Care Manual that will prove to be a useful resource to underpin the advancement of critical care practice and education. The next few years will reveal readers’ views.

Scope

The Critical Care Manual differs from the RMH Manual in several ways. First, the focus is patients who are critically ill (levels 1 to 3, based on the classification devised in England [DH 2000]). The text, therefore, is aimed at a wide range of practitioners caring for critically ill patients, or those who are undertaking education in this area. Second, the patient and their requirements are seen as central to the management of critical illness. This necessitates a multidisciplinary team approach rather than individual profession-based procedures and competencies (although it is understood that a specific group of professionals is more likely to undertake some of the procedures than others). Third, to assist further with integrated governance and education, fundamental and specific competencies have been developed and incorporated into the chapters.

The emphasis of the Critical Care Manual is ‘general’ critical care. Specialist critical care, such as that provided for patients with severe burns and/or large wounds, was felt to be beyond the scope of this particular version. This has enabled the first edition of the Critical Care Manual to be detailed, in depth and to include some specific management of patients. However, the editors would welcome practitioners’ opinions on areas that it would be appropriate to include in the next edition. Organ donation may be one such topic.

Organisation and content

The Critical Care Manual has been broadly organised to guide practitioners from the tenets of critical care and the imperative for practitioner competency, through recognition of clinical deterioration, immediate critical care and care of those with multi-organ failure.

More specifically, the text first elucidates the develop­ment of the most recent concepts of critical care and its classification. The nature of evidence-based practice and, importantly, the principle of patient-centred practice is also debated (Chapter 1). In relation, Chapter 2 covers the relevance of competency-based practice to healthcare delivery and puts forward a framework for fundamental and procedure-related competencies (Fundamental Competency Statements and Specific Procedure Competency Statements respectively). The former are based on the fundamental patient needs highlighted within the Essence of Care 2010 (DH 2010) and include essential concerns such as communication, respect and dignity, pain management and safety, etc. When demonstrating competency to conduct a procedure it is important that both Fundamental and Specific Procedure competencies are met. This is because the inclusion of assessment of fundamental care facilitates a shift from evidence-based practice towards a more patient-centred approach. Every chapter includes Specific Procedure Competency Statements associated with each procedure. However, for brevity the Fundamental Competency Statements are not repeated in each chapter. The competency statements have been designed to be able to be easily used in differing organisations’ documentation.

The subsequent chapters cover the management of critical illness through a patient’s potential journey, including inter alia:

timely recognition of a deteriorating and critically ill patient on the ward (Chapter 3 provides an immediate perspective of assessment and interventions which are expanded in depth in later chapters)admission to a critical care unit (Chapter 4)clinical assessment and monitoring specific systems, such as the respiratory and cardiovascular systems, and neurological statusclinical management of particular aspects of critical illness, for instance hydration and nutrition (via oral, enteral and parental routes); tissue viability; mouth and eye hygieneclinical interventions, for example titration of inotropic and vasopressor medication; continuous renal replacement therapy; analgesia and neuromuscular blockade; sleep promotion; physical mobility and exercise interventions (Chapters 5 to 14)physiological effects of the transfer of critically ill patients (such as horizontal and vertical gravitational forces) (Chapter 15)rehabilitation from critical illness (Chapter 16)withdrawal of treatment and end of life care (Chapter 17)cardiopulmonary resuscitation using the latest guidance from the Resuscitation Council (Chapter 18).

It is hoped that the Critical Care Manual will be of use to practitioners outside Europe, although it has been written from a UK perspective.

Acknowledgements

The Critical Care Manual would never have come to fruition without the expertise, understanding and guidance of my fellow editors, John Albarran and Annette Richardson, both of whom are eminent in the critical care arena. They have shown great patience as I have attempted to deconstruct the rationales for ‘this is the way it is done’.

I would also like to thank all the authors for their diligence, thoroughness and professionalism in producing an excellent and readable final manuscript – sometimes to a very short deadline. I hope they are pleased with the outcome.

In addition, I would like wholeheartedly to thank the staff at Wiley-Blackwell for their support and dedication. In particular, and throughout the whole process, Beth Knight has been an exceptional and kind guide. Also, Catriona Cooper, for her hard work, clarity and support; and Rachel Coombs and James Benefield, who provided help at the beginning of the process.

Finally I would like to thank Ruth Swan, for her serenity and unfailing assistance in the closing stages of ‘proofing’.

Jane Mallett

Consultant in Health Care Development

References

Department of Health (2000) Comprehensive Critical Care: a review of adult critical care services. London: DH.

Department of Health (2010) Essence of Care 2010. London: DH.

List of abbreviations

2,3-DPG2,3-diphosphoglycerate 5-FU5-fluorouracilAACaugmentive or alternative communicationAACCNAmerican Association of Critical Care NursesABCDEairway, breathing, circulation, disability, exposureA&EAccident and EmergencyABGarterial blood gasABPIAnkle to Brachial Pressure IndexADHantidiuretic hormoneADLactivities of daily livingADRadverse drug reactionAEDautomated external defibrillatorAFOankle foot orthosisAHPallied health professionalAIDSacquired immune deficiency syndromeAKIacute kidney injuryALARPas low as reasonably practicableALIacute lung injuryALSadvanced life supportALTalanine aminotransferaseANHacute normovolaemic haemodilutionANPatrial natriuretic peptideANSautonomic nervous systemANTTaseptic non-touch techniqueAORNAssociation of Perioperative Registered NursesAPanteroposteriorAPTRactivated partial thromboplastin ratioARDSacute respiratory distress syndromeARSACAdministration of Radioactive Substances Advisory CommitteeASTaspartate aminotransferaseATanaerobic thresholdATCaround the clockAVatrioventricularBACCNBritish Association of Critical Care NursesBALbronchoalveolar lavageBCGbacille Calmette-GuérinBCSHBritish Committee for Standards in HaematologyBEbase excessBIAbio-electrical impedance analysisBiPAPbi-level positive airway pressure ventilationBIPAPbi-level ventilationBLSbasic life supportBMABritish Medical AssociationBMEblack and minority ethnicBMIBody Mass IndexBNFBritish National FormularyBOCBritish Oxygen CompanyB/P SphygsphygmomanometerBPIBrief Pain InventoryBSEbovine spongiform encephalopathyCADcoronary artery diseaseCARESCancer Rehabilitation Evaluation SystemCAUTIcatheter-associated urinary tract infectionsCBTcognitive behaviour therapyCCAcritical care assistantCCUcritical care unitCDcontrolled drugcfucolony-forming unitsCIPNMcritical illness polyneuromyopathyCJDCreutzfeldt–Jakob diseaseCMLchronic myeloid leukaemiaCMVcytomegalovirusCNScentral nervous systemCOcardiac outputCOADchronic obstructive airways diseaseCOMACommittee on Medical Aspects of Food PolicyCOPDchronic obstructive pulmonary diseaseCOSHHControl of Substances Hazardous to HealthCPAPcontinuous positive airway pressureCPETcardiopulmonary exercise testingCPPcerebral perfusion pressureCPRcardiopulmonary resuscitationCRRTcontinuous renal replacement therapyCRPC-reactive proteinCSASChemotherapy Symptom Assessment ScaleCSFcerebrospinal fluid/colony-stimulating factorCSSCentral Sterile ServicesCSUcatheter specimen of urineCTcomputed tomographyCVADcentral venous access deviceCVCcentral venous catheterCVPcentral venous pressureCVVHcontinuous veno-venous haemofiltrationCVVHDcontinuous veno-venous haemodialysisCVVHDFcontinuous veno-venous haemodiafiltrationCXRchest X-rayDBEdeep breathing exercisesDFdorsiflexionDFLSTdecision to forego life-sustaining treatmentDHDepartment of HealthDICdisseminated intravascular coagulationDMdiabetes mellitusDMSOdimethyl sulphoxideDNAdeoxyribonucleic acidDNACPRdo not attempt cardiopulmonary resuscitationDNMBDdepolarizing neuromuscular blocking drugDO2oxygen deliveryDPIdry powder inhalerDREdigital rectal examinationDVLADriver and Vehicle Licensing AgencyDVTdeep vein thrombosisEAPCEuropean Association of Palliative CareEBMevidence-based medicineEBNevidence-based nursingEBPevidence-based practiceEBRTexternal beam radiotherapyEBVEpstein–Barr virusECFextracellular fluidECGelectrocardiogramECMextracellular matrixECMOextracorporeal membrane oxygenationEDTAethylenediaminetetra-acetic acidEEGelectroencephalogramEGFRepidermal growth factor receptorEIAEquality Impact AssessmentELISAenzyme-linked immunosorbent assayEMGelectromyogramEMLAeutectic mixture of local anaestheticsEMSelectrical muscle stimulationENTears, nose and throatEOGelectro-oculogramEOLCend of life careEPOerythropoietinEPUAPEuropean Pressure Ulcer Advisory PanelERVexpiratory reserve volumeETCO2end tidal CO2ETTendotracheal tubeEUPAPEuropean Pressure Ulcer Advisory PanelF(Fr)French (gauge)FBCfull blood countFCSfundamental competency statementFEESfibreoptic endoscopic evaluation of swallowingFFIfatal familial insomniaFFPfresh frozen plasmaFiO2fractional inspired oxygenFRCfunctional residual capacityFTSGfull-thickness skin graftFVCforced vital capacityGABAgamma-aminobutyric acidGCSGlasgow Coma ScaleG-CSFgranulocyte-colony stimulating factorGEDVglobal end diastolic volumeGEFglobal ejection fractionGFRglomerular filtration rateGGTgamma-glutamyl transferaseGIgastrointestinalGMCGeneral Medical CouncilGM-CSFgranulocyte macrophage-colony stimulating factorGPgeneral practitionerGSLgeneral sales listGTNglyceryl trinitrateHADSHospital Anxiety and Depression ScaleHBsAghepatitis B surface antigenHBVhepatitis B virusHCAhealthcare assistantHCAIhealthcare-acquired/associated infectionHCVhepatitis C virusHDNhaemolytic disease of the newbornHDRhigh dose rateHDUhigh-dependency unitHEPAhigh-efficiency particulate airHFOVhigh-frequency oscillation ventilationHIVhuman immunodeficiency virusHLAhuman leucocyte antigenHMEheat and moisture exchange(r)HOOFhome oxygen ordering formHPAHealth Protection AgencyHRheart rateHSCHealth Service Circular/Health and Safety CommissionHSEHealth and Safety ExecutiveIASPInternational Association for the Study of PainIBCTincorrect blood component transfusedICinspiratory capacityICDimplantable cardioverter defibrillatorICFintracellular fluidICPintracranial pressureICRPInternational Commission on Radiological ProtectionICSintraoperative cell salvageICSIintracytoplasmic sperm injectionICUintensive care unitIgMimmunoglobulin MIJVinternal jugular veinILCORInternational Liaison Committee on ResuscitationIMVintermittent mandatory ventilationINRinternational normalized ratioIPCTinfection prevention and control teamIPEMInstitute of Physics and Engineering in MedicineIPPBintermittent positive pressure breathingIRMERIonizing Radiation (Medical Exposure) RegulationsIRRinfra-red radiationIRVinspiratory reserve volumeISCintermittent self-catheterizationITBVintrathoracic blood volumeIVintravenousIVCinferior vena cavaIVFin vitro fertilizationIUIintrauterine inseminationJPACJoint UKBTS/NIBSC Professional Advisory CommitteeKGFkeratinocyte growth factorKVOkeep vein openLANSSLeeds Assessment of Neuropathic Symptoms and SignsLBCliquid-based cytologyLCP-ICULiverpool Care Pathway for Intensive Care UnitsLCTlong-chain triglycerideLDRlow dose rateLMAlaryngeal mask airwayLMNlower motor neuroneLMWHlow molecular weight heparinLPlumbar punctureLPALasting Power of AttorneyLVEDPleft ventricle end diastolic pressureMACMycobacterium avium intracellulareMAOImonoamine oxidase inhibitorMAPmean arterial pressureMBPmean blood pressureMC&Smicroscopy, culture and sensitivityMCTmedium-chain triglycerideMDAMedical Devices AgencyMDImetered dose inhalerMDTmultidisciplinary teamMEmedical examinerMETmedical emergency teamMEWSModified Early Warning SystemMHRAMedicines and Healthcare Products Regulatory AgencyMImyocardial infarctionMICminimum inhibitory concentrationMLDmanual lymphatic drainageMPQMcGill Pain QuestionnaireMRImagnetic resonance imagingMRSAmeticillin-resistant Staphylococcus aureusMSASMemorial Symptom Assessment ScaleMSCCmetastatic spinal cord compressionMSUmidstream specimen of urineNANDANorth American Nursing Diagnosis AssociationNAVAneurally adjusted ventilatory assistNBTCNational Blood Transfusion CommitteeNCEPODNational Confidential Enquiry into Patient Outcome and DeathNEWSNational Early Warning SystemNDNMBDnon-depolarizing neuromuscular blocking drugNGnasogastricNHSNational Health ServiceNHSCSPNHS Cervical Screening ProgrammeNHSENational Health Service ExecutiveNICENational Institute for (Health and) Clinical ExcellenceNIVnon-invasive ventilationNMCNursing and Midwifery CouncilNMDAN-methyl-d-aspartateNMDSneuromuscular blocking drugNPAnasopharyngeal airwayNPSANational Patient Safety AgencyNPUAPNational Pressure Ulcer Advisory PanelNPWTnegative pressure wound therapyNRSnumerical rating scalesNRTnicotine replacement therapyNSAIDnon-steroidal anti-inflammatory drugNSATNewcastle Sleep Assessment ToolNSFNational Service FrameworkODPoperating department practitionerOGDoesophagogastroduodenoscopyONSOncology Nursing SocietyOPAoropharyngeal airwayOSCEobjective structured clinical examinationOToccupational therapistOTCover the counterOTFCoral transmucosal fentanyl citratePpharmacy medicinesPAposterior anteriorPaCO2partial pressure of carbon dioxidePACUperi-anaesthesia care unitPADpreoperative autologous donationPAO2partial pressure of alveolar oxygenPAPpulmonary artery pressurePARTpatient-at-risk teamPAWPpulmonary artery wedge pressurePCPneumocystis cariniiPCApatient-controlled analgesiaPCEApatient-controlled epidural analgesiaPCSpostoperative cell salvagePCV-VGpressure control ventilation-volume guaranteePDPHpostdural puncture headachePDTpercutaneous dilatational tracheostomyPEpulmonary embolism/pulmonary embolusPEApulseless electrical activityPEEPpositive end-expiratory pressurePEF(R)peak expiratory flow (rate)PEGpercutaneous endoscopically placed gastrostomyPEPpostexposure prophylaxisPETpositron emission tomographyPFplantar flexionPGDpatient group directionPGSGApatient-generated subjective global assessmentPHCTprimary healthcare teamPICCperipherally inserted central catheter (long line)PNparenteral nutritionPNSperipheral nervous systemPOApreoperative assessmentPOCTpoint-of-care testingPOMprescription-only medicinePPEpersonal protective equipmentPPVpulse pressure variationPrPprion proteinPSARPain and Assessment RecordsPSCCprimary/benign spinal cord compressionPSDpatient-specific directionpsipounds per square inchPTphysiotherapistPTFEpolytetrafluoroethylenePTHrpparathormone-related polypeptidePTSDpost traumatic stress disorderPTSS-14Post Traumatic Syndrome 14 Question InventoryPUOpyrexia of unknown originPVCpolyvinylchloridePVDperipheral vascular diseasePVRpulmonary vascular resistancePWOpartial withdrawal occlusionRAright atriumRAPright atrial pressureRASreticular activating systemRASSRichmond Agitation and Sedation ScaleRBCred blood cellRCAroot cause analysisRCNRoyal College of NursingRCSRoyal College of Surgeons of EnglandRCUKResuscitation Council UKREMrapid eye movementRIGradiologically inserted gastrostomyRNIreference nutrient intakeROSCreturn of spontaneous circulationRSVrespiratory syncytial virusRSVPreason, story, vital signs, planRTOResuscitation Training OfficerRTOGRadiation Therapy Oncology GroupRVresidual volumeSAsinoatrialSABRESerious Adverse Blood Reactions and EventsSARSsevere acute respiratory syndromeSaO2arterial oxygen saturationSBARSituation-Background-Assessment-RecommendationSBOsmall bowel obstructionSCCspinal cord compressionSCIspinal cord injurySCNSSupportive Care Needs SurveySCUFslow continuous ultrafiltrationSDFstromal cell-derived factorSGAsubjective global assessmentSHOTSerious Hazards of TransfusionSISystème InternationalSIMVsimulated intermittent mandatory ventilationSIMV-PCsynchronized intermittent mandatory ventilation pressure controlSIMV-VCsynchronized intermittent mandatory ventilation volume controlSIRSsystemic inflammatory response syndromeSLsemi-lunarSLDsimple lymphatic drainageSLEsystemic lupus erythematosusSLEDDsustained low-efficiency daily diafiltrationSLTspeech and language therapistSNRIserotonin-norepinephrine reuptake inhibitorSOPstandard operating procedureSPCSspecific procedure competency statementSPISocial Problems InventorySPNSafer Practice NoticeSpO2saturation of haemoglobin by oxygenSRHHSelf-Report Health HistorySSGsplit-thickness or split skin graftSSIsurgical site infectionSSRIselective serotonin reuptake inhibitorSUIserious untoward incidentSVstroke volumeSVCsuperior vena cavaSvO2mixed venous oxygen saturationSVRsystemic vascular resistanceswgstandard wire gaugeTACOtransfusion-associated circulatory overloadTA-GVHDtransfusion-associated graft-versus-host diseaseTBtuberculosisTCAtricyclic antidepressantTCItarget-controlled infusionTEDthromboembolic deterrentTENStranscutaneous electrical nerve stimulationTIVAtotal intravenous anaesthesiaTLCtotal lung capacityTLDthermoluminescentTNPtopical negative pressure therapy TPITreponema pallidum immobilizationTPNtotal parenteral nutritionTRALItransfusion-related acute lung injuryTRSCTherapy Related Symptom ChecklistTSEtransmissible spongiform encephalopathyTSStoxic shock syndromeTTtracheostomy tubeTTOto take outTURPtransurethral resection of prostateTVtidal volumeUHunfractionated heparinUMNupper motor neuroneUTIurinary tract infectionV/Qventilation/perfusionVADvascular access deviceVAPventilator-associated pneumoniaVATvenous assessment toolVCvital capacityvCJDvariant Creutzfeldt–Jakob diseaseVCVvolume control ventilationVDRLVenereal Disease Research LaboratoryVDSverbal descriptor scalesVEGFvascular endothelial growth factorVFventricular fibrillationVPFvascular permeability factorV/Q ratioventilation/perfusion ratioVttidal volumeVTventricular tachycardiaVTEvenous thromboembolismVTMviral transport mediumWBCwhite blood cellWBPwound bed preparationWHOWorld Health OrganizationWOBwork of breathingWRWassermann reaction

Chapter 1

Scope and delivery of evidence-based care

John W. Albarran1 and Annette Richardson2

1University of the West of England, Bristol, UK

2Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

Importance of critical care

Healthcare around the world, to a greater or lesser degree, encompasses the treatment and care of people with a wide range of conditions. Some will be critically ill and clinical decisions and interventions will have immediate and fundamental impact on whether they live and/or their degree of recovery. It is, therefore, imperative that treatment and care of critically ill patients is the best that can be provided. Excellence, however, requires appropriate interventions with a strong evidence base and practitioners1 who are com­petent to deliver treatment and care. The aim of Critical Care Manual of Clinical Procedures and Competencies is to support optimum treatment and care for patients who are critically ill by detailing the latest research and rationales for evidence-based procedures and competencies in each specific area. As such, the manual is ideally placed to be used as a reference and resource for advancing critical care practice and education.

Background and classification of critically ill patients

Critical care2 has developed considerably over many years, with a number a key policies and initiatives emphasizing and escalating the pace of change. A significant transformation took place following the publication of the critical care modernisation policy document entitled ‘Comprehensive Critical Care’ (DH 2000a). This strategy document led to a restructure of the organization of critical care services by advocating that provision of care should extend beyond the walls of intensive care units and be comprehensive in meeting patients’ needs. It highlighted the provision of care within a continuum of primary, secondary and tertiary care, with the greater part of services in the secondary care setting. It set out the vision for how critical care should be delivered, replacing the division of intensive care beds and high dependency beds with a classification system focused on levels of care (). ‘Critical care’ is a global definition, and is used as an umbrella term for intensive and high dependency care and includes the care of critically ill patients on the ward ( 2000a: 7).