Page 56 - ACCCN's Critical Care Nursing

Resourcing Critical Care 33

the incidence of mortality at hospital discharge was ● provision of training and education to support less
higher in patients discharged from an ICU with a TISS experienced staff
of >20 points than in those with a TISS of <10 points ● development of critical care nursing teams in which
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(21% versus 4%). TISS was not, however, developed critical care expertise is spread across the teams to
as a predictive tool – rather as a record of the level manage the patient load appropriately, i.e. in satel-
of nursing intervention required. One study noted lite units
that patients with longer ICU stays and worse quality- ● planning for critical care staff sick leave
of-life (QOL) outcomes did not have the increase in ● provision to redeploy pregnant staff
resource consumption that would have been predicted, ● provision of training and education of all staff to
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as reflected by their TISS. A number of direct-care avoid panic and concern, for example, domestic and
nursing activities were not captured by TISS-28 (e.g. catering staff.
hygiene, activity/movement, information and emo-
tional support), and a revised instrument, the nurs- Stuff
ing activity scale, was developed to address those The ability to manage supplies at times of uncertain
limitations. 81 demand is a key element for examination, as is the
knowledge and understanding of the processes for access-
ing additional equipment such as ventilators and medica-
MANAGEMENT OF PANDEMICS tions from state emergency stockpiles, for example:
● Ensure supplies of appropriate personal protective
Planning for the impact, or potential impact, of a pan- equipment (PPE).
demic is required at the organisational and operational ● Develop plans/policies for the rational use of PPE.
levels, as is the identification of its direct clinical implica- ● Ensure supplies, and access to supplies, of required
tions. This section highlights the areas to be considered medications.
at the organisational level when assessing the response of ● Plan ability to boost ventilator capacity, such as with
an individual facility to such an event. increased use of BiPAP or accessing state emergency
Intensive care beds and their associated resources (equip- stockpile.
ment and staffing) are finite resources and an organisa-
tional response is required to maximise potential ICU Space
capacity. Lessons can be learnt from the global H1N1 This would examine and plan for strategies to function-
pandemic in 2009. The knowledge gained from this expe- ally increase the available critical care bed capacity, as
rience clearly identifies the need to plan for the potential follows:
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increased demand on critical care services. While it is
beyond the scope of this chapter to cover this subject ● Defer elective surgery.
comprehensively, the aim is to outline briefly the areas ● Explore the ability of local private hospitals to assist
for further examination, touching on the concept of the with service provision for non-deferrable surgical
development of a surge plan. cases.
● Identify alternative clinical areas within the hospital
In earlier experience 98–102 the key role that critical care that may provide additional critical care beds as a
units have to play in an organised response to a pan- satellite unit, such as recovery and coronary care.
demic, particularly an airborne one such as influenza, has ● Triaging access to limited ventilation and/or critical
been demonstrated, as has the reality that critical care care resources. 100,103
units have been more severely affected than other clinical
areas of a hospital. Demand for these services will, at
these times, exceed normal supply. CRITICAL CARE SURGE PLAN
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The NSW Department of Health provides a template
for the development of a critical care surge plan. This is
DEVELOPMENT OF A SURGE PLAN formatted in a graduated approach and is shown as a
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Hota et al. describe the preparations for a surge to percentage of current capacity:
service under the three headings ‘Staff, Stuff and Space’. ● pre-surge
The resources required will be examined under these ● minor surge: 5%–10%
headings. ● moderate surge: 11%–20%
● major surge: 21%–50%
Staff ● large scale emergency >50%

The ability to staff a potentially expanded critical care bed The use of such a template, which can be populated
base should examine the following: with locally appropriate definitions and information,
can provide the basis for a comprehensive unit/facility
● staff with critical care skills who do not currently work specific response to the requirement for a graduated
in this area response to a pandemic. Planning for events such as a
● staff from other areas with critical care based skills, pandemic require a coordinated, collaborative approach
such as recovery, anaesthetics, coronary care from all members of the healthcare team, resulting