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Critical care without borders

Posted: 16 December 2019

Picture of the nurses

Sharing expertise beyond the walls of the Intensive Care Unit.

- 24/7 Critical Care Outreach service - providing follow up for ICU patients, responding to the deteriorating patient on the ward, part of the fractured NOF pathway and the emergency laparotomy pathway. Outreach also support the NIV service overnight.

- Follow up service for patients and relatives post ICU

- Designing pathways and training programmes for inter-hospital transfer across London.

A multi-disciplinary improvement drive at WHHT’s Critical Care Unit has resulted in better outcomes for patients, staff, and colleagues across London’s hospitals.

The unit at Watford General Hospital is one of the biggest for its size in the country.

It has a high number of specialist hospital transfers, a large local population.

Staff in the department has collaborated to tackle the challenges over the last 12 months through robust training programmes, interhospital pathway transfer reviews, outreach and awareness campaigns.
Critical Care Consultant Dr Nazril Nordin said: “All the initiatives are all now showing success. Our ethos is to share our expertise beyond the walls of the intensive care unit. This benefits the ward staff who get trained with expert advice directly from the critical care team.’

Outreach Service
All intensive care patients discharged to the wards are reviewed by a specialist Critical Care nurse, trained to recognise the sick patient and manage the high-risk patient after major surgery. They give tailored support and advice to nursing staff on the ward to prevent patients returning to a critical care bed.

Follow Up Service
It is well known that patients are at risk of post-traumatic stress disorder after time in the Intensive Care Unit so all discharged patients receive a call at home from an Critical Care nurse and are invited to come to a clinic once a month to see a consultant with any or psychological or physical problems after intensive care.
A ‘bereavement call’ service is also routinely carried out to check on the mental health of relatives of the deceased.

Staff Training
- Over the last year 60 members of staff have had specialist Simulation Suite training. The sessions were centred around managing acute clinically deteriorating patients in intensive care and the work has resulted in improved confidence, team working and leadership skills for working in crisis.

- The department also runs an eight day in-house ‘Critical Care Foundation Course, which is aligned to The Standards for Competence for Registered Nurses. This ensures all Band 5 staff in the unit have a strong initial understanding of critical care nursing. Staff are trained in acute airway skills such as tracheostomy management. They have also shared learning with colleagues in the Emergency Department, theatres, stroke wards.

- More than 100 staff nurses have been trained this year in the Acute Life-threatening Events--Recognition and Treatment (ALERT) TM course. The one-day multidisciplinary course was originally designed to give newly qualified doctors and nurses greater confidence and ability in the recognition and management of adult patients who have impending or established critical illness.

- Staff also receive in-house training in invasive procedures such as central line insertion, arterial cannulation, chest drain insertion, lumbar puncture, tracheostomy on procedural study days.

Inter hospital Transfer Pathway Improvement Programme
The team work together with the Emergency Department at Watford General Hospital at Watford to improve transfers and reduce complications while transferring critically ill patients.
Organ Donation

We are a leading centre on appropriate referrals to organ donation service to ensure that our patients have their wishes honoured at their most difficult time. As a unit we also actively promote the organ donation day around the hospital, using the up to date campaign of ‘Pass it on’ around the new law changes in regards to organ donation.

The team is proud to be part of a number of major international clinical trials such BLING, a study which looks at the use of antibiotics in critically ill patients with sepsis.

Dr Page, Critical Care consultant has published extensively in the field of Intensive Care delirium and is a world recognised expert in the field.

Critical Care Consultant Dr Nazril Nordin added: “Hopefully all of our work means our staff are more aware and happier and comfortable in their roles and improve the retention of staff and ensure that our patients are better cared for and our reputation is one to be proud of.

“We are also a very progressive unit and want to be ahead of the curve and keep up to date in the trials in intensive care – we are not stopping here, it’s part of our Critical Care vision for the future for all of us.


Notes to editors

  1. For more information, please contact the communications team on: 01923 436280 or email: Out of hours, please call 07900 228031.
  2. West Hertfordshire Hospitals NHS Trust serves people from across Hertfordshire, north London and further afield. It operates from three hospitals; Watford General, St Albans City and Hemel Hempstead. The trust has a catchment area of over 500,000 people and is one of the largest employers locally, with around 5,000 staff and volunteers.
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