Critical Care Requirements Essay

As defined by the American Association of Critical-Care Nurses Critical care nursing is that specialty within nursing that deals specifically with human responses to life-threatening problems. Critical care units (CCUs) or intensive care units (ICUs) are intended to meet the special necessities of acutely and critical care patients.Critical Care Requirements Essay

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Critical care nurses are responsible for the care of patients with acute and unstable physiologic problems, including their caregivers. Critical care nurses’ role include assessing life-threating conditions, commencing appropriate interventions, and evaluating the outcome of each intervention. This type of nurses are very knowledgeable in anatomy, physiology, pathophysiology, pharmacology, advanced skills and possess the ability to manipulate advanced biotechnology. To rapidly recognize and manage complications these nurses do frequent assessments to monitor patterns in the patient’s physiologic parameters such as BP, and EKG. When taking care of their patients, critical care nurses often face ethical dilemmas which can lead to emotional exhaustion or burnout. As a result, it is very important that all team members maintain healthy work environment.
According to AACN a critically ill patient is one who is at high risk for actual or potential life-threating health problems and who requires intense and attentive nursing care. Patients are generally admitted to the ICU for one of three reasons. One, a physically unstable patient requiring sophisticated clinical judgment. Two, patients at risk for serious complications requiring frequent assessments and often invasive interventions. And three, patients may need intensive and complicated nursing support due to the use of polypharmacy and advanced biotechnology.Critical Care Requirements Essay

This essay sets out to discuss the importance of comprehensive and accurate assessment on a registered nurses’ ability to make excellent clinical decisions. It will examine what factors can change a nurses’ capability to be aware of, and act on abnormal assessment findings. As well as assessment being part of the nursing process that is used in every day nursing, it is also a critical part of patient safety (Higgins, 2008). Assessment findings are used to determine what needs to be done for the patient next. Early warning scoring systems currently exist to aid in the early detection of patient deterioration (Goldhill, 2005). The rationale for the use of these systems is that early recognition of deterioration in the vital signs  Critical Care Requirements Essay
The issue of consistency is raised when discussing how to ensure assessments are comprehensive, complete and that the data is recorded using the same guidelines as other nurses. To enable consistency of assessment, the same nurse should be taking the observations of a patient for the duration of a shift (Moore, 2007). This ensure that the interpretation of results don’t differ each time the vital signs are done. It also allows the nurse to detect subtle changes in the patients state that may not have been written down. For example, in most clinical environments the respiration rate is recorded as just a number, and the rhythm, degree of effort, quality of breathing and evidence of wheezing or other abnormal breathing sounds are not recorded. The rate may stay the same over a period of time while other aspects of respiration may change, and this is something that a nurse is more likely to notice if they have assessed that patient before. During handover, a nurse should tell the next nurse looking after their patients how they took observations and detail what tools they used to ensure consistency is maintained. Nurses may not pick up on abnormal assessment findings because they do not know what the normal ranges are, or perhaps do not know what combinations of abnormal clinical Critical Care Requirements Essay

Walking into the hospital at 6:40am you badge in and make your way to the floor, just minutes into your shift you hear the intercom buzz “code blue, 1A, code blue 1A”. Almost immediately you hear the front doors of the floor flying open and staff members rushing in. Those staff members, are ones from the Intensive Care Unit or ICU. Nurses from the ICU are specially trained in the care of critically ill patients with special needs for extensive monitoring. Critically ill patients are defined as those patients who are at high risk for actual or potential life-threatening health problems. The more critically ill the patient is, the more likely he or she is to be highly vulnerable, unstable and complex, thereby requiring intense and vigilant nursing care (AACCN, 2016, para. 2). Critical care nursing is a job that is very well respected, but with that respect comes a lot of responsibility and education as this job will continue to evolve over the years.Critical Care Requirements Essay
In the event that one decides critical care nursing is where their future resides, you must first figure out where to start in your education. Prospective registered nurses must complete a graduate program which should include classes such as Anatomy and Physiology, Microbiology, and other social and behavioral sciences. Students will also be involved in a clinical setting where they will explore core nursing subject such as ethics, mental health, and pharmacology. Nurses who want to work in critical care must obtain a bachelor’s degree of nursing. The path from RN to ICU nurse can vary from state to state. For example, typically in Delaware you work your way up the chain. Perhaps starting on a Med Surg unit, and then getting some experience in a progressive care unit

How to Become a Critical Care Nurse
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A critical care nurse (CCN) is a nurse with specialized training, knowledge, and skills to provide care to acutely ill patients. A CCN offers care to patients with healthcare demands that require close monitoring. A critical care nurse should take care of 1-3 critically ill patients at a time in an intensive care unit (ICU), but this is just an ideal number. The number of patients can increase beyond the three especially at places where staff shortage in rife. Someone who wants to offer critical care nursing should follow specific steps to attain the position.Critical Care Requirements Essay

Steps to Becoming a Critical Care Nurse
Enroll for a nursing program
The first step is for nurses to finish the nursing studies to become a registered nurse. It is a prerequisite requirement for critical care nurses to be registered nurses before they enter this specialized field of nursing. Most employers prefer critical care registered nurses (CCRNs) with a Bachelor of Science degree in nursing. Some start by getting an Associate’s degree level, but it is essential for nurses who want to be CCNs to consider academic qualifications before writing their applications.

Obtain licensing to become a registered nurse
Each state has it set of requirements for nurses to earn their registered nurse license. It is essential to visit the state board of nursing website at the state where you plan to practice and determine the eligibility requirements. Nurses obtain a license to practice after passing NCLEX-RN the (national council licensure exam for registered nurse).Critical Care Requirements Essay

Earn the relevant experience
Critical care nursing requires certification that nurses can only get if they have particular expertise in a critical care field. The period to gain experience in intensive care settings is also an opportunity for exploring desires to become a certified critical care nurse. Experience in critical care nursing is somewhat significant because it is a requirement that a nurse must fulfill before obtaining a CCRN certification.

Get a Critical Care Registered Nurse Certification
Nurses who pass the licensure exam to practice become eligible for CCRN certification. Certification is not a requirement to work in the critical care settings, but many nurses in working environments choose to get CCRN training and credentials that they get through professional associations such as American Association of Critical-Care Nurses (AACN) in the USA.Critical Care Requirements Essay

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CCRN-E certification is available for registered nurses who work are roles where they monitor the critically ill patients through technologies from remote locations and cameras. CCRN certification is also available to those working in critical care environments and issues, but they do not provide direct patient care.

Nurses who take the AACN route provides training and certification test to RNs aspiring to become critical care nurses in the neonatal, pediatric or adult field. A nurse can fulfill the requirement by AACN for CCRN certification by choosing one of these options:Critical Care Requirements Essay

1. 1,750 hours experience working as an APRN or RN offering direct care to acute/critical patients for the past two years. 875 of these hours should be from the most recent year before application.

2.Five years experience that includes a minimum 2,000 hours to work directly with the critically or acutely ill patients. I44 hours should be in the most recent year before the application.

After determining the eligibility, AACN informs the applicants about the fee they should pay to take a computer-based exam and get a CCRN certification that is valid for three years after passing the examination.Critical Care Requirements Essay

CCRN Recertification for a Critical Care Nurse
CCRN recertification takes place three years after getting the first certification. CCNs should apply for recertification to maintain their eligibility for the role. Those applying to for recertification should have these qualifications in place.

1. Experience of 432 hours or providing direct care to critical/acute patients during the three-year certification period. 144 of these hours should be in the past 12 months before the renewal date.

2. 100 units of Continuing Education Recognition Points in three categories covering areas of caring practice, diversified care, collaboration, and clinical inquiry.

3. Recertification candidates can also use the option passing a renewal exam instead of obtaining the 100 units of CERPs above.

Critical care nursing is a specialty that healthcare professional regard as a valuable practice in caring for patients with acute illnesses. It is a hectic career that suits staff nurses with interest to specialize in a high charged nursing specialty.Critical Care Requirements Essay

An intensive care unit (ICU), also known as a critical care unit (CCU), intensive therapy unit or intensive treatment unit (ITU) is a special department of a hospital or health care facility that provides intensive care medicine. ICUs were developed for coronary care later their role expanded to include all critically ill patients. The ICU concept was adopted by most large, tertiary referral as well as by community hospitals in 1960s.Intensive care units cater to patients with the most severe and life threatening illnesses and injuries, which require constant, close monitoring and support from specialist equipment and medication in order to ensure normal bodily functions. They are staffed by highly trained doctors and critical care nurses who specialize in caring for seriously ill patients. Common conditions that are treated within ICUs include trauma, multiple organ failure and sepsis.[1]Critical Care Requirements Essay
Patients may be transferred directly to an intensive care unit from an emergency department if required, or from a ward if they rapidly deteriorate, or immediately after surgery if the surgery is very invasive and the patient is at high risk of complications. Hospitals may have ICUs that are specific to certain specialty or patient, example of these are neonatal intensive care unit, Paediatrics intensive care unit, psychiatric intensive care unit also there is out of hospital ICU which is called Mobile intensive care unit.
Some equipments used at ICU are mechanical ventilators, cardiac monitors including those with telemetry; external pacemakers; defibrillators; dialysis equipment;equipment for the constant monitoring of bodily functions; a web of intravenous lines, feeding tubes, nasogastric tubes, suction pumps, drains, and catheters; and a wide array of drugs to treat the primary condition(s) of hospitalization. Medically induced comas, analgesics, and induced sedation are common ICU tools needed and used to reduce pain and prevent secondary infections. Bed Head Unit/Panel, Medical Rail System also called as Wall Utilizer.
ICU admission criteria should select patients who are likely to benefit from ICU care .Situations involved patients who were at the two extremes of the risk of death spectrum; relatively low risk of death and exceedingly high risk of death. These groups can be referred to as “too well to benefit” and “too sick to benefit” from critical care services. ICU care has been demonstrated to improve outcome in severely ill, unstable patient populations. Defining the “too well to benefit” and “too sick to benefit” population may be difficult solely based on diagnosis. For example, drug overdose patients are commonly admitted to an ICU. The following are some specific conditions or diseases that are appropriate for ICU admission, Acute myocardial infarction with complications, cardiogenic shock, complex arrhythmias requiring close monitoring and intervention, acute congestive heart failure with respiratory failure and/or requiring hemodynamic support, hypertensive emergencies, unstable angina, particularly with dysrhythmias, hemodynamic instability, or persistent chest pain, cardiac arrest, cardiac tamponade or constriction with hemodynamic instability, dissecting aortic aneurysms, complete heart block, acute respiratory failure requiring ventilatory support, pulmonary emboli with hemodynamic instability, massive hemoptysis, respiratory failure with imminent intubation, acute stroke with altered mental status, coma: metabolic, toxic, or anoxic, intracranial hemorrhage with potential for herniation, acute subarachnoid hemorrhage, meningitis with altered mental status or respiratory compromise, central nervous system or neuromuscular disorders with deteriorating neurologic or pulmonary, brain dead or potentially brain dead patients who are being aggressively managed while determining organ donation status, vasospasm, hemodynamically unstable drug ingestion, drug ingestion with significantly altered mental status with inadequate airway protection, seizures following drug ingestion, Life threatening gastrointestinal bleeding including hypotension, angina, continued bleeding, or
with comorbid conditions, fulminant hepatic failure, diabetic ketoacidosis, complicated by hemodynamic instability, altered mental status, respiratory insufficiency or severe acidosis, thyroid storm or myxedema coma with hemodynamic instability, hyperosmolar state with coma and/or hemodynamic instability, severe hypercalcemia with altered mental status, requiring hemodynamic monitoring,hypo or hypernatremia with seizures altered mental status, hypo or hypermagnesemia with hemodynamic compromise or dysrhythmias,hypo or hyperkalemia with dysrhythmias or muscular weakness, hypophosphatemia with muscular weakness<.Critical Care Requirements Essay
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LITERATURE REVIEW
The modern intensive care unit (ICU) is the highest mortality unit in any hospital. There are approximately 5 million ICU admission in USA and the incidence is still rising in developing countries like Tanzania it is not documented but it might be higher than we expect. The ICU is also one of the sites in which medical errors are most likely to occur because of the complexity of care. Since the patient population is severely ill and undergoes multiple complex interventions at the same time, these patients are extremely vulnerable to experiencing adverse outcomes
A study done by T. Baker et al on emergency and critical care services in Tanzania found that Emergency care was similarly lacking in structure and facilities at most hospitals also seven out of ten hospitals involved in the study had no ICU.1
A 5 year study of 1308 patients done on outcome from intensive care from 1979 to 1983 at Harlev Hospital Denmark, results shows male to female ratio is 1:1, respiratory diseases (43%) and cardiovascular diseases(16%) were the most primary indication for ICU admission. Increasing age was associated with more frequent cardiovascular diseases.10 Critical Care Requirements Essay

In a study of BP Lwezimula, Determinants of outcome for medical cases admitted at MNH ICU(2003) results show that tetanus is the leading admitted case at ICU(44.2).Similar result was documented in a study of Mwafongo V et al, Tetanus and treatment outcome in Dar es Salaam: need for male vaccination(2005).6,7
In a study published by university of San Fransisco California showed that average mortality rate reported ranging from 8-19%, or about 500,000 deaths annually.6
The Society of Critical Care Medicine (SCCM) reports that overall mortality rates in patients admitted to adult ICUs average 10% to 29%.Also reports the leading causes of death in the ICU are multiorgan failure, cardiovascular failure, and sepsis. Multiorgan failure has a mortality rate of 11% to 18%. Sepsis, the second leading cause of death in noncoronary ICUs, carries a mortality rate of 25% to 30%. Of patients who are diagnosed with sepsis, up to 51% will develop acute renal failure, up to 18% will have acute respiratory failure, and up to 80% will develop a myopathy or polyneuropathy.8
In a study Causes of death and determinants of outcome in critically ill patients by Viktoria Mayr and colleagues from Innsbruck Medical University collaborated with colleagues from other institutions in Austria results show that 47% of patients who died in the ICU died of multiple organ dysfunction.4 Critical Care Requirements Essay
Although patients in intensive care units (ICUs) receive care for a large variety of disease states, the leading causes of death in the ICU are multiorgan failure, cardiovascular failure, and sepsis. Multiorgan failure has a mortality rate of 11% to 18%. Sepsis, the second leading cause of death in noncoronary ICUs, carries a mortality rate of 25% to 30%. Of patients who are diagnosed with sepsis, up to 51% will develop acute renal failure, up to 18% will have acute respiratory failure, and up to 80% will develop a myopathy or polyneuropathy. Overall mortality rates in patients admitted to adult ICUs average 10% to 29%. Recent studies have shown that the pediatric mortality rate associated with sepsis is 13.5%, whereas the overall mortality rate for pediatric ICU patients ranges from 2% to 6%. A mortality rate of 6.04% has been reported in ICUs with intensivist staffing compared with 14.4% when a non-intensivist attending provides care.6

A study on stroke patients in Australian teaching hospital ICU was done between January 1994 and December 1999 to determine the mortality rate and functional outcome of stroke patients admitted to the ICU.Stroke was found to be associated with high mortality rate and high likelihood of dependent life style after ICU discharge.9
PROBLEM STATEMENT
Medical patients suffer a high mortality after critical illness however the causes of mortality after intensive care management are unclear.
There is a need to conduct a study to explore the factors affecting outcomes and identify the most common causes of ICU admission in our settings.Critical Care Requirements Essay

RATIONALE
The outcome of ICU patients is well studied and documented in developed countries it is less documented in developing countries like Tanzania.Tanzania is low resource country having a large burden doctor to patent ratio which contribute to the poor outcome to patients admitted to the ICU as well as in general ward also caring for admitted patient to ICU is costflul interms of money both to the institution and the patients all of these contribute to the outcome of the patient.
There is a need to conduct a study so as to fill the existing clinical information gap and thus critical and quality care can be provided to the patient.

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OBJECTIVES
Broad objective
To determine common indications for admission and mortality outcome at MNH main ICU
Specific objectives
1. To assess common indications for ICU admission at MNH main ICU.
2. To determine the influence of patients age on mortality outcome at MNH main ICU.
3. To determine the influence of sex on patient mortality outcome at MNH main ICU.
4. To determine the influence of length of stay on patient mortality outcome at MNH main ICU.
5. To determine the influence of diagnosis on the patient mortality outcome at MNH main ICU.
METHODOLOGY Critical Care Requirements Essay
Study design
The study type descriptive retrospective study.
Study area;
MNH main ICU.
Study population;
Patients admitted to the main ICU at MNH

Sample size
Will be computed from the following formula
N = Z2 p (1 ‘ p)
e2
Where:
N = sample size
Z = percentage of normal distribution corresponding to the level of significance.
Taking significance level to be 5% then Z = 1.96
p = prevalence of patients prescribed analgesics postoperative following caesarean section.
Taking p = 50% for maximum sample size.
e = margin error which is 5%
N = (1.96)2 x 0.5(1 ‘ 0.5)
(0.05)2
= 384
Due to time limitation for data collection sample size will be 100
Sampling method;
Simple random sampling will be used to get admitted patients at the main ICU in MNH.
Inclusion criteria;
The study will involve all patients who are admitted to the main ICU at MNH and are willing to participate also who are above 18 years old,ICU stay equal or more than 4 hours
Exclusion criteria;
All patients admitted to the main ICU at MNH and are not willing to participate and are bellow 18 years old.Burn patients,readmitted,ICU stay less than 4 hours and trauma patients.For those who are unconscious if their relative refuse to participate.
Data collection technique;A check list which record patient’s age,sex,diagnosis,length of stay and patient’s outcome will be noted.
Data analysis;
Data will be analyzed by using SPSS 17.Critical Care Requirements Essay
Ethical consideration;
Real names will not be used during data collection instead code numbers will be used so as to ensure confidentiality also ethical clearance will be obtained from MUHAS ethical clearance committee.
Study limitation;
Poor patient recorded information and unwillingness of the patient to participate
Work plan;
The study will be conducted in 8 weeks period, in accordance with the following plan.

ACTIVITY Week 1&2 Week 3&4 Week 5&6 Week 7&8
1 Collection of basic information from MUHAS Administration

2 Data collection

3 Data entry and analysis

4 Report writing

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BUDGET ESTIMATION (in Tshs)
ITEM QUANTITY UNIT PRICE TOTAL COST
PROPOSAL DEVELOPMENT
Proposal preparation 02 7500 15,000
Photocopying (checklist) 100 150 15,000

MATERIALS
Pencils 04 100 400
Rubber 02 250 500
Pens 04 200 800
Rim papers 01 12,000 12,000
Scientific calculator 01 30,000 30,000
Spring files 02 4,000 8,000
Punching machine 01 5,000 5,000
Stapler machine 01 5,000 5,000
Office pins 01 2,000 2,000
DATA COLLECTION, ANALYSIS AND REPORT WRITING
Meals and accommodation allowance (56 days) 56 8,000 448,000
Report preparation 01 20,000 20,000
Contingency (10%) 1 56,170 56,170
GRAND TOTAL 617,270
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CHECKLIST

Patient Eligibility
A.) Patient age is or greater than 18 years during admission at ICU ‘ YES ‘ NO/Unknown
If NO,EXCLUDED
B.) Is this his/her first ICU admission’? YES ‘ NO/Unknown
If NO,EXCLUDED Critical Care Requirements Essay
C.) Did the patient cared more than 4 hours at ICU? ‘ YES ‘ NO/Unknown
If NO,EXCLUDE
D.) Was the patient admitted due to Trauma or Burns, ‘ YES ‘ NO/Unknown
If YES,EXCLUDED
Part II;Patient Identification
a. Patient’s code : ___________________________________
b(i). DOB: ___/___/____ b(ii). Age:_____
c. SEX: Male ‘ Female ‘
Part III. Hospital Arrival / Index ICU Admission
The index ICU admission is the first ICU admission (of ‘ 4 hours) during a hospitalization.
II-1 HOSPITAL Arrival (MNH)DATE ___/___/____ TIME: _ _ : _ _

II-2 ICU Admission DATE ___/___/____ TIME: _ _ : _ _
II-3 Number of day at ICU:_____________

PART IV. PLACE BEFORE ICU ADMISSION
III-1 Please indicate the care place before ICU Admission (Choose One Below, i-vi)
‘ i. MNH ‘ v. Rehabilitation Unit (Skip to IV-A)
‘ ii. Another Acute-Care Hospital ‘ vi. Direct Admit ‘ Physician (Skip to IV-A)
‘ iii. Home (move to IV-A)
‘ iv. Other _________ (move IV-A)
IV-1a If you chose ‘i’ (MNH) ‘ Indicate the department/unit care site prior to ICU
admission.(select One)
‘ Ward ‘ Operating Theatre or Recovery Room
‘ Emergency Department ‘ Other ICU
‘ Unknown
Section V. Patient condition on ICU Admission
IV-A Was the patient receiving mechanical ventilation at ICU admission or ‘YES ‘NO ‘UNKNOWN
within one hour after arrival to the ICU?
IV-B Cardiopulmonary resuscitation within 24 hours prior to ICU admission? ‘YES ‘NO’UNKNOWN
IV-C Did the patient have surgery before ICU admission? ‘ YES’N0 ‘UNKNOWN
IV-D(a) If YES to IV-4 Was the Surgery:
‘ Scheduled
‘ Unscheduled
IV-D( b) If Unscheduled ‘Was the Surgery:
‘ Emergent
‘ Non-Emergent
IV-E Life support status at admission to the ICU: (Choose One)
‘ Full Code
‘ Limited Interventions/Withholding Therapy
‘ DNR/ No CPR
‘ Withdrawing Therapy/ Comfort Care
‘ Maintenance of circulatory support ‘ Unknown
for organ procurement
Section V. immediate Diagnoses
At ICU admission, please indicate whether any of the following acute diagnoses are present (Select ALL that apply):
Cardiac Arrhythmias / Rhythm Disturbance (do NOT include chronic, stable arrhythmias) Critical Care Requirements Essay
‘ Atrial fibrillation / flutter with rapid ventricular response (HR ‘ 100)
‘ Other supraventricular: SVT / PSVT / WPW
‘ 2nd degree or 3rd degree heart block
‘ Ventricular tachycardia / fibrillation
‘ Other rhythm disturbance, not chronic / not stable
Cardiac Surgery
‘ Patient admitted to ICU after cardiac surgery
Gastrointestinal Bleeding (includes only clinically apparent GI bleeding. Examples include hematemesis, coffee ground emesis, or melena; a drop in hematocrit or perforated ulcer alone is NOT sufficient)
‘ Upper GI bleed from esophageal varices / or
portal hypertension
‘ Upper GI Bleed, other source
‘ Lower GI Bleed
‘ GI Bleed, unknown source
Sepsis
‘ Sepsis present
Renal
‘ Acute renal failure OR Acute on chronic renal
failure, Prerenal type
‘ Acute renal failure OR Acute on chronic renal
failure, Non-prerenal type
‘ Acute renal failure OR Acute on chronic renal
failure, Unknown type
Neurologic
Coma or Deep Stupor: (Does not include coma/deep
stupor secondary to physician administered paralytic
and/or sedative medications).
‘ Coma or deep stupor, traumatic
‘ Coma or deep stupor, non-traumatic
‘ Coma or deep stupor, due to drug overdose
Cerebrovascular Incident:
‘ Arteriovenous malformation with
subarachnoid hemorrhage or stroke /
hemorrhage
‘ Cerebrovascular accident / CVA /stroke
(embolic and/or thrombotic)
‘ Epidural hematoma
‘ Subarachnoid hemorrhage / intracranial Critical Care Requirements Essay
aneurysm (bleeding)
‘ Subdural hematoma
‘ Intracranial hemorrhage / hematoma, other
Section VI. Medical History
Does the patient have any of the following medical conditions / treatments that have been diagnosed, symptomatic,or ongoing in the six months prior to admission? (Select all that apply).
Hepatic Oncologic
‘ Confirmed cirrhosis
‘ Metastatic disease, solid tumor type (metastasis
‘ By Biopsy
‘ Other/Not Known identified by clinical assessment or biopsy proven)
‘ Portal hypertension
‘ Chronic myelogenous or chronic lymphocytic
‘ Jaundice and Ascites leukemia AND active treatment
‘ Esophageal and/or gastric varices
‘ Chronic myelogenous or chronic lymphocytic
‘ GI bleed attributable to portal hypertension leukemia AND at least one of the following (e.g. variceal bleed) complications secondary to the leukemia: sepsis,
‘ Hepatic encephalopathy anemia, stroke caused by clumping of white blood cells, tumor lysis syndrome, pulmonary edema, or Renal ARDS
‘ Renal dysfunction w/out dialysis but baseline ‘ Acute myelogenous or acute lymphocytic leukemia,
creatinine >2.0 mg/dL (>176.8umol/L) multiple myeloma, or other acute hematologic
‘ Chronic dialysis (Hemo or CAPD/Peritoneal) malignancy
‘ Lymphoma
Section VII. Mental Status
Using the Glasgow Coma Score (GCS) table below:
VII-1 What was the patient’s GCS at admission to the ICU? For patients under the effects of paralytic or
sedative medications use your best clinical judgment to estimate the GCS prior to initiation of sedation.
(Please use Scale 1 below if not intubated or Scale 2 below if intubated).
EYE ____ MOTOR ____ VERBAL ____
VII-1a Please indicate if GCS from VII-1 is: ‘ Physician / nurse documented ‘ Abstractor Estimated
VII-2 Was the patient’s level of consciousness significantly depressed due to the
effects of sedative or paralytic agents at admission to the ICU? Yes ‘ No ‘
Section VIII. Discharge Critical Care Requirements Essay
VIII-1 ICU Discharge DATE: ___/___/____ TIME: _ _ : _ _

VIII-2 HOSPITAL Discharge DATE: ___/___/____ TIME: _ _ : _ _

VIII-3 Status of patient at ICU discharge:
‘ Stable ‘ Heart still beating but under consideration for organ donation
‘ Dead ‘ Discharged for comfort care with no expectation of recovery
If the patient died in the ICU ‘code status at death (Choose one):
‘ Full Code ‘ Limited Interventions/Withholding Therapy
‘ DNR/ No CPR ‘ Maintenance of circulatory support
‘ Withdrawing Therapy/ Comfort Care for organ procurement
‘ Unknown
VIII-4 Status at HOSPITAL discharge: Alive ‘ Dead ‘
If alive at HOSPITAL discharge ‘what was the disposition of the patient?
‘ Home ‘ Hospice
‘ Against medical advice ‘ Other
‘ Another Acute Care Hospital ‘ Unknown
‘ Intermediate Care / Resident Care Facility Critical Care Requirements Essay