Tuesday, 21 May 2013

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Intensive Care Unit

Schedule Contact Description History Dept. Services

Operating Schedule   Back to top

Nursing Personnel

Area Manager – Ms. Rochelle A. Romualdo, RN

Unit Manager – Mr. Lamberto N. Alarcio, RN

Staff Nurses – 26

Nursing Aides – 8

Ward Clerks – Mr. Charlie Palacious

The nursing staff on duty completes a 12 – hour duty and rotates every 2 weeks. Each staff is assigned to patient with a ratio of 1:2. The charge nurse or the senior staff on duty determines the staff assignment.

Medical Personnel

One (1) medical Resident on twenty – Four (24) hours duty

ICU Officer – Dr. John Anonuevo (Cardiologist)

One (1) Pulmonary fellow

Contact Numbers Back to top

• Direct line/Telefax: 523–9116
• ICU Trunk line: 523–3011 local 8118 or 2100
• CCU Trunk line: 425–3011 local 2110 or 2111

Service Description  Back to top

Service Description of the unit and its objectives

The Medical Intensive Care Unit (MICU) is specialized area equipped with monitoring, diagnostics and therapeutic devices designed to provide intensive observation, continuous monitoring and care for cardiac and non cardiac medical, surgical, obstetric and pediatric patients who are in an unstable vital condition or who may urgently require treatment on life support systems. It is an open ICU, wherein the Primary Attending Physicians are still responsible for the care of their patients who are admitted directly to the ICU, or transferred from another unit of the hospital. An MICU team of consultants is however responsible for the day-to-day training and service requirements of the MICU.

The MICU is composed of 10 rooms, two of which are designed as isolation rooms. Each room is equipped with a cardiac monitor, connected to a central monitor located at the nurse’s station. These cubicles are also equipped with piped in oxygen and suction, BP apparatus and resuscitator bags. The nurse’s station at the middle of the unit maintains the central monitor. All rooms are equipped with cardiac monitors which features BP, HR, RR, SaO2, temperature monitoring. Two have capneugraphs, with facility for pressure monitoring with arterial lines and/or pulmonary artery catheters for hemodynamic monitoring.

The Cardiac Care Unit (CCU) located at the 4th Floor of the main MDH building. The CCU provides care to patients with a variety of cardiac illness and other critical medical issues. The CCU is also the unit where patients recovers after heart surgery or have undergone a special procedure such as cardiac catheterization with complications or with PTCA. The CCU’s doctors and nurses, educated to recognize any problems patients could have following surgery, observe, monitor and evaluate patients very close. The CCU staff provides personalized and specialized patients care around the clock, seven days a week. A CCU team of cardiologists is responsible for the training and service requirements of the CCU. The nursing staff receives specialized training in the care of patients with cardiac arrhythmias, chest pains, heart failure and other critical medical conditions.

The Stroke Unit (SU) is also located at the 4th floor on the main MDH building, within the MICU unit. There are three beds allocated for stroke patients. The SU provides care to patients with a variety of cerebrovascular illness and other critical neurological issues.

The Telemetry unit is likewise located at the 4th floor beside the CCU unit. It consists of two rooms. The telemetry heart monitoring is standard care after surgery.

Each cubicle is equipped with a cardiac monitor, connected to a central monitor located at the nurse’s station. These cubicles are also equipped with piped in oxygen and suction, BP apparatus and resuscitator bags. The nurse’s station at the middle of the unit maintains the central monitor. The cardiac feature BP, HR, RR, SaO2, Temperature monitoring.

The MICU-CCU—Telemetry-Stroke Units also maintain a mini central supply and pharmacy units, stock and linen room for easy and prompt accessibility of patient needs.

1. Standard Equipped per Room
1. Electric Bed with side rails
2. Bedside cardiac monitor
3. Bedside table and cabinet and over bed tables
4. Piped in oxygen, compresses air and suction
5. IV hooks and IV stand
6. Resuscitator bags
7. Individual split-type air conditioning unit
2. Standard Equipment in the Unit
1. One (1) NIHON KOHDEN ECG Machine
2. Ten (10) bedside cardiac monitors – ten (10) are capable of VS monitoring and pressure monitoring
3. Central monitors – located at the nurses’ station
4. Three (3) nellcor pulse oximeters
5. Three (3) Pulse Generators
6. Infusion Pumps
7. Enteral Feeding Pumps
8. Syringe Pumps
9. Portable Suction Machine

History  Back to top

Healing as a vocation was started by Aesculapius in Greece, centuries before the birth of Christ, which then spread through the whole of Greece and reached Rome by the third century B.C. Hospital have also been established in China at about this same period as well as Ceylon. In the centuries that followed, religious organizations, whether Christian, Buddhist. Islamic or other sectors were mainly responsible for the care of the sick.

In modern history, hospital have evolved into centers of learning and specialized medical care of high quality. Over and above the advances of medical science and technological developments that has made medical care more accurate with diagnosis and management, the tradition of sympathetic understanding, empathy, and compassion for the sick remains in all hospitals.

Most modern hospitals have evolved intensive care units (ICU) where those with critical illness are given the utmost care, both in terms of personnel as well as medical equipment. The ICU therefore plays an important role in any hospital, both in terms of its ability to support patients who may have otherwise succumbed to their illness, as well as the high level of requirements for manpower, equipment, and other resources.

At the Manila Doctors Hospital, its ICU was established in the early 1980’s, starting with just 2 beds. Since then, it has evolved into the present unit consisting of 10 beds. It has now opened three new sections: (1) the Cardiac Care Unit (CCU) (2) the Telemetry Unit and (3) the Stroke Unit (SU). As in the early hospitals, the MDH MICU-CCU-Telemetry-Stroke Units will continue to serve the very sick patient with the same zeal, compassion, and knowledge and skills. This manual is intended to guide the staff of the MICU-CCU-Telemetry-Stroke Units in handling most issues and concerns pertaining to the management of patients.

Department Services  Back to top

ADMITTING PROCEDURES

All ICU-CCU admissions are classified as private cases. The ICU Senior Nurse reserves the right to assign the room and not the Admitting Department to the patients.

1. Request for admission to the ICU-CCU is made by Attending Physician
2. The nurse in the unit where the patient is coming from notifies the ICU and instructs the family to secure a transfer slip at the admitting section.
3. The Accounting department gives clearance for the transfer
4. The floor or unit nurse is responsible for getting the consent for transfer.
5. The ER or floor nurse informs the ICU-CCU of the working diagnosis of the patient, contraptions attached to the patient and the preparations needed. They must accompany and endorse the patient properly to the ICU-CCU staff and should notify all department concerned and the AP of the patient.
6. Reservations for the ICU-CCU beds will be honored for eight (8) hours only and will be on first come, first served basis except for ongoing surgical procedure that may exceed this limit. However, the ICU-CCU Committee through the ROD reserves the right to prioritize admissions of more pressing or serious cases.

TRANSFER AND DISCHARGE

1. Patients who may no longer need intensive care may be transferred out if cases of priority are to be admitted.
2. The Attending Physician determines the order for transfer to other unit or floor.
3. Transfer to another area requires a transfer slip signed by the Accounting and Admitting Clerk.
4. ICU-CCU nurse accompanies the patient during transfer and make complete endorsement to the unit nurse who includes patient’s data, condition, contraptions attached, present medications and treatment and other special endorsement. He/she should be accompanied by the 1sy yr. ROD.

OXYGEN

All patient will receive oxygen by cannula 2LPM from admission until modified by physician’s order or if patient is incubated prescribed FIO2 is administered and modified by the Pulmo fellow / Resident or the Attending Physician, himself.

VITAL SIGNS

1. Blood Pressure (BP) record every thirty (30) minutes or more frequently till stable then every hour.
2. Pulse Rate (PR) and Respiratory Rate (RR) should be recorded at the same time as BP.
3. Temperature should be checked every four (4) hours and as necessary.
4. Neuro status of the patient is monitored every hour or more frequently when necessary, for all neuro cases through the use of the Glascgow Coma Scale.

ECG MONITORING

All patients must be connected to the cardiac monitor.

FLUIDS

1. A dependable IV line with 250 – 500cc D5W unless changed by the physician or heparin lock should be set up. A percutaneous catheter with CVP monitoring may be used when indicated.
2. Fluids intake shall be determined by the physician.

URINE AND BOWEL MOVEMENT

All patients admitted in the ICU-CCU –Telemetry – Stroke Units should be placed on complete bed rest unless otherwise ordered by the physician.

PHYSICAL CARE

Routine physical hygiene which includes daily sponge bath, oral care, dressing and linen changes are done every night.

The resident should do dressing within the first 24 hours unless otherwise ordered by the physician. After 24 hours, the ICU – CCU – Telemetry – Stroke Staff may be allowed to change and maintain dressing aseptically. Such dressings include cut down or CVP, intrajugular or subclavian catheter dressing and tracheostomy care.

ICU-CCU GUIDELINES FOR VISITORS

1. Only immediate family members and relatives, seven (7) years of age and above, shall be allowed to enter the unit one or two at a time within the specified visiting hours:
2. To help prevent cross – infection, the visitors must wash their hands prior to their entry and exit in the unit.
3. While inside the unit, visitors are requested to:
4. Food and flowers are not allowed inside the unit. Written get-well messages maybe posted with permission from the unit staff.
5. Taped music maybe allowed for the patients provided that tape recorders/radios are battery operated.

THE MICU – CCU - STROKE GALLERY SERVES AS WAIVING ROOM FOR PATIENT’S RELATIVES, WITH THE FOLLOWING GUIDELINES:

1. Only two relatives residing outside Metro Manila are allowed to sleep at the gallery from 9:00 PM to 5:00 AM.
2. Relatives staying at the gallery are requested to maintain the silence, cleanliness and orderliness at all times.
3. Eating meals inside the gallery is prohibited.
4. Recharging of electrical gadgets (cell phones, radios, etc.) at the gallery circuit outlets is prohibited. Overloading can hazardous affect functioning of cardiac monitors and respirators attached to the patients.
5. Communication to the ICU – CCU – Telemetry – Stroke staff shall be made through installed intercom units.
6. Valuables must be deposited at the Accounting Department for safekeeping. The ICU – CCU – Telemetry - Stroke staff and the hospital shall not be held responsible for the losses within the premises.

Schedule Contact Description History Dept. Services

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