Table of Contents

Infection Control

Medication Safety

Nutrition

Pressure Injuries

Falls Prevention

Restraints

Blood Administration

REACH Calls

Patient safety is an essential component of high-quality care provided in the ICU. Our team have worked hard to establish a number of tools and strategies that ensures the ICU provides safe care, in the context of evidence-based practice and the National Safety and Quality Health Service (NSQHS) requirements.

Some of these standards cover infection control (Standard 3), medication safety (Standard 4), nutrition, prevention and management of pressure injuries and falls, restraints (Standard 5) and administration of blood products (Standard 7).

Please refer to the following sections that provide further information on how we uphold patient safety within the ICU.

Infection Control (NSQHS 3)

Infection Control in the ICU is extremely important because patients are unwell and are therefore more susceptible to developing hospital acquired infections (HAI). HAIs are the most common complication affecting patients in hospital. It is important that we all work together to help prevent the spread of germs and promote safety within the ICU.

Patients and families are considered part of our team to ensure a safe and healthy environment.

We ask that you please adhere to the following rules to help us prevent the spread of HAIs: 

• Please do not visit the ICU if you are feeling unwell with any symptoms such as a cough, running nose, sneezing, fever, rash, vomiting or diarrhoea in the last 72 hours.  

• Please do not eat or drink in the ICU. You may bring in food for your loved one, but please check with the bedside nurse before giving it to the patient.  

• Please do not sit on the patient’s bed or touch any of the patient’s equipment.

• Please don’t place your belongings on the floor or on the patient’s bed.  

• Please follow proper respiratory hygiene – if you do need to cough or sneeze, please do so into a tissue or your elbow and wash your hands afterwards. 

For more information please refer to the fact sheets below:

Hand Hygiene

Hand hygiene is recognised as the cornerstone of infection prevention and can reduce the risk of transmission of germs to patients, staff, and visitors.  

When you enter the ICU please use the basins to your left to wash your hands with soap and water or use the alcohol based hand rub which will evaporate.

It is also important while you are visiting your loved one that you continue to perform hand hygiene after you touch your face, go to the toilet, blow your nose, etc. Alcohol based hand rub can be found in the patient’s bed area and throughout the ICU for your convenience.  

Please access the following fact sheets for more information:

Isolation

Occasionally patients may be placed in isolation or under transmission-based precautions. These precautions are used to help stop the spread of germs from one person to another and to stop germs from spreading across a healthcare setting. Some germs are spread by touching a contaminated item and others can be spread by coughing or spraying droplets into the air. If the person you are visiting is being nursed under these precautions, please talk to the bedside nurse before entering their bedspace/room. You may be required to wear additional protective clothing.

For more information on transmission-based precautions please see the following facts sheets: https://www.safetyandquality.gov.au/our-work/infection-prevention-and-control/resources-consumers

Medication Safety (NSQHS 4)

In the ICU, medication safety is a key priority area during admission, transitions of care and when being discharged to the ward. There are several strategies in place to ensure that our patients remain safe when receiving medications.

Each patient will wear two identical identification bands, either on their wrists or ankles, which will either be clear, indicating no allergies or red, alerting to a medication allergy or sensitivity. All nurses are expected to carry out the 5 rights of administration when handling medications which involves ensuring the right patient, the right time, the right dose, the right route and the right drug. In addition, two nurses will check high risk medications together.

If your family member arrives with prescribed medications that are restricted in the hospital setting, these medications need to be locked in the unit’s medication cupboard and written within the drug register. The bedside nurse may ask you to take home any medications that are not required, if safe to do so. Please ensure that you clarify with the nurse or medical team before taking any medications home. All other medications will be stored in the patient’s bedside medication drawer which remains locked when not in direct use by the bedside nurse.

The medical team will collect information regarding a patient’s medication history from numerous resources which include the hospital’s health records/medication histories, their local General Practitioner, the patient themselves (if appropriate) or from family members and carers. Please mention to the bedside nurse or medical team if your family member’s high priority or long-term medications are not being administered. However, some of the patient’s regular medications can inhibit effectiveness of lifesaving or time-critical medications, or their route is not available when the patient is newly admitted, therefore may not be given. Please communicate any medication concerns or questions to the bedside nurse or medical team. A referral may be made to our ICU Pharmacist for further assistance.

Nutrition (NSQHS 5)

Nutrition therapy is a vital part in the care of your loved one within the ICU. Nutrition plays an important role in improving a patient’s condition and recovery in hospital. It is considered a therapy, much like medications and other treatments, and needs to be optimally delivered and managed over the course of a patient’s ICU stay and transfer to the ward.

Optimal nutrition therapy means giving people the correct amount and type of nutrition. This helps by improving wound healing, boosting the immune system, and reducing the risk of infection, improving the function of the stomach, reducing mortality rates and hospital length of stay and improving overall physical recovery from critical illness.

Nutritional support can be delivered in various forms, depending on whether your loved one is able to eat or drink. The patient may receive their nutrition via tube feeding, intravenous (IV) feeding (a combination of both) or via oral nutrition. Our team of dieticians conduct detailed assessments of our patients, combined with discussions with family members/carers and the medical team, to ensure the most appropriate nutritional support is prescribed.

Please refer to the educational posters below:

• Improve your family member's appetite

• Intravenous feeding

• Nutrition Therapy: Role of a Dietitian

• Thickened fluids

• Tube feeding

If you have any further questions please talk to the bedside nurse who can refer you onto the ICU dietician for further information.

Pressure Injuries (NSQHS 5)

Critically ill patients are at increased risk of developing painful pressure injuries or “bedsores”. This can be due to the severity of illness, the patient lying in bed for long periods of time or the skin becoming damaged from constant pressure or friction pressing against the body. Pressure injuries can occur when the skin begins to fail due to various reasons including the inability to move freely/frequently, poor blood circulation due to low blood pressure, low oxygen levels, inadequate nutrition or being over/underweight.

The ICU has a dedicated team that focuses on this important preventable adverse event, working together with the rest of the ICU staff to identify and prevent pressure injuries from a number of causes. The ICU has developed several strategies combined with hospital wide policies and procedures in order to predict and prevent pressure injuries. Depending on a patient’s level of risk, the care provided may include regularly being moved/turned if the patient cannot move themselves, the use of turning assisted devices or lying on special mattresses that reduce pressure. Included in these strategies is ensuring that patients, families, and carers are informed of the risks as well as the prevention and management plans that are in place.

Please speak to the nurse if you would like more information.

Falls Prevention (NSQHS 5)

Although a rare event within the ICU, critical care patients are at high risk of falling and can result in devastating physical and psychological consequences. Therefore, the emphasis on falls assessment and prevention is a key priority.

In our ICU we have a falls prevention team that work to ensure that the risk of falls is minimal and that there are various screening tools and harm minimisation management plans in place to uphold patient safety and best practice. Assessments for the risk of falls are conducted on all our patients within 8 hours of presentation to the unit or when the patient’s condition changes, when deemed appropriate or after a fall has occurred. In addition, there are a number of individualised prevention strategies that are initiated by the staff including, discussions with the patient and their families about history of falls and changes in mental or mobility status, orientation to the ICU environment, ensuring that the appropriate aids are used when mobilising, encouraging the use of eyewear and hearing aids if required, ensuring the call-bell button is within reach and initiating a plan of assistance when patients want to mobilise.

The ICU prioritises a multidisciplinary approach to the prevention of falls and ensures that the appropriate members of the team are involved including physiotherapy and occupational therapy, as well as ongoing discussions with family and carers to uphold holistic care of our patients.

Restraints (NSQHS 5)

There may be a time that you see your loved one with restraints on their arms. In ICU restraints are used as a last resort to keep your loved one safe. At times patients can become confused or agitated and try to pull out lines such as cannulas and breathing tubes., compromising their safety. Both nurses and doctors will try prevention strategies, however if unable to settle your loved one we may have to apply restraints. These are removed as soon as they are no longer required. The types of restraints used in our ICU include soft restraints, mittens and lockable restraints.

If you have any questions about restraints you can speak to the bedside nurse, medical team or nurse in charge.

Blood Transfusions (NSQHS 7)

Often times when a patient in the ICU is critically unwell, they may require a blood transfusion.

A blood transfusion is a life-saving medical procedure where blood is given intravenously (into a vein). The patient may be prescribed a blood transfusion to replace blood that has been lost due to an accident, operation, or illness. Other reasons include when the body is not making enough blood or the blood is not working properly. The medical team will recommend a blood transfusion when the benefits outweigh the possible risks and there are rigorous procedures in place within the ICU to ensure that administration is safe. One of the ICU doctors will discuss with the patient or their family about the need for a blood transfusion, along with the benefits, risks and alternatives.

For more information, please refer to the following brochure:

REACH

If you notice a worrying change in your family member please speak with the bedside nurse or medical team about your concerns. If you are still concerned, a REACH call may be appropriate.

For more information, please ask the bedside nurse, Clinical Nurse Unit Manager or access the following fact sheet: