What are the key guidelines to memorize for patient safety and effective care while on ICU (Intensive Care Unit) rotation?

Key Guidelines to Memorize for ICU Rotation

The most critical guidelines to memorize for ICU rotation focus on patient positioning, early mobilization, safety protocols, and proper medication administration, as these directly impact patient mortality and morbidity outcomes.

Patient Positioning and Ventilation Management

• Upper body elevation of 30-45° is recommended for ventilated patients to reduce the incidence of ventilator-associated pneumonia (VAP) and gastric reflux 1
• For patients with brain injury, head positioning should be individualized with regular monitoring of cerebral perfusion pressure (CPP) and intracranial pressure (ICP) at different elevations (0°, 15°, 30°) 1
• The head should be positioned straight in all positions to ensure proper venous return 1
• Prone positioning for ARDS patients should be implemented for 12-16 hours daily when PaO₂/FiO₂ < 150 mmHg and ventilation duration < 36 hours to achieve significant survival benefit 1
• Prone positioning should be started within 48 hours of mechanical ventilation initiation for optimal effect 1
• Avoid flat supine position except when absolutely necessary for procedures 1

Sedation and Medication Safety

• For ICU sedation with propofol, initiate slowly with continuous infusion to minimize hypotension 2
• Most adult ICU patients require propofol maintenance rates of 5-50 mcg/kg/min (0.3-3 mg/kg/h), with administration not exceeding 4 mg/kg/hour unless benefits outweigh risks 2
• Allow a minimum of 5 minutes between propofol dosage adjustments to observe peak drug effect 2
• Evaluate sedation level and CNS function daily to determine minimum required dose 2
• Use strict aseptic technique when handling propofol, as it can support microbial growth despite containing preservatives 2
• Propofol administration must be completed within 12 hours after vial opening, with IV lines flushed every 12 hours 2

Fire Safety and Emergency Protocols

• Ensure familiarity with evacuation routes and practice "walk-through" training every 2 years 1
• ICU fire alarms should be audible throughout the department unless specifically turned off by clinicians 1
• Each ICU bed space should have appropriate evacuation equipment stored in easily accessible locations 1
• Ensure proper oxygen cylinder storage and handling according to supplier instructions 1
• Maintain ventilation of >10 air changes per hour in areas using high-flow nasal oxygen, CPAP, or non-invasive ventilation to prevent oxygen enrichment of ambient air 1

Critical Incident Monitoring and Patient Safety

• Implement a voluntary, anonymous, non-punitive critical incident reporting system to identify potential errors before major incidents occur 1
• Formalize handovers between clinicians with standardized checklists to prevent communication failures 1
• Organize ICU rounds to be undisturbed, allowing intensivists to concentrate on patient inspection 1
• Recognize that hierarchical structures can negatively impact safety; encourage open communication across all team members 1
• Monitor both complications and critical incidents to identify system issues before patient harm occurs 1

Workplace Organization

• Ensure adequate staffing ratios appropriate to patient acuity 1
• Implement strategies to mitigate fatigue from shift work, including proper lighting during night shifts (at least 2500 lux) to maintain staff alertness 1
• Maintain separation between clean and dirty utility areas to prevent cross-contamination 3
• Design clean utility rooms (15 m²) for storing sterile supplies and preparing materials, with proper air conditioning and positioning within 30 meters of patient care areas 3

Implementation of Guidelines and Protocols

• Foster a culture that enables guideline implementation through effective leadership and positive interprofessional team dynamics 4
• Use standardized protocols, care bundles, and order sets to facilitate measurable processes and outcomes 5
• Implement the ABCDEF bundle (Assess and manage pain, Both spontaneous awakening and breathing trials, Choice of analgesia/sedation, Delirium assessment/management, Early mobility, Family engagement) 6
• Provide education tailored to different professional groups with repeated interventions, reminders, and feedback 4
• Use simple guideline formats and electronic media to improve adherence 4

Common Pitfalls and How to Avoid Them

• Avoid abrupt discontinuation of propofol prior to weaning or daily sedation assessment, as this may cause anxiety, agitation, and resistance to mechanical ventilation 2
• Prevent medication errors by implementing double-checks at nursing shift changes 1
• Avoid prolonged immobilization in the same position, which increases risk of pressure injuries 1
• Recognize that higher degrees of upper body elevation can increase intraabdominal pressure 1
• Be aware that conflicts in the workplace can negatively impact performance and patient safety; implement structures to identify and resolve conflicts 1