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INTENSIVE CARE: Why the voice of patients and their families is essential

Care in an intensive care unit is not a trivial experience, neither for the patient nor for his family. And, beyond the technicality or even the urgency of the care, the well-being of the patient and his relatives is a decisive factor in the quality of care. This study from the Beth Israel Deaconess Medical Center (Harvard, Boston), which looked at the attitudes of patients and their families faced with such an experience in an intensive care unit (ICU), shows the importance of the latitude left by the care team to speak freely about their care concerns. This aspect of the caregiver-patient relationship appears to be just as essential as coordination within the team for health outcomes.

Previous studies have shown that when all members of the clinical care team communicate and “feel comfortable,” team performance improves. However, in-depth knowledge of patients' wishes, their medical history and the reactions of their families contributes to a more efficient care offer because it is centered on the patient. Patients and families must therefore also “feel comfortable” sharing their concerns about care with the medical team. This study took a closer look at this opportunity for patients and their loved ones to express themselves in real time in the context of the ICU.

Clinician researchers from the Beth Israel Deaconess Medical Center (BIDMC) asked patients and relatives who had recently experienced an ICU hospitalization about their ability to express their wishes and wishes to caregivers. Specifically the team interviewed 105 families of patients admitted to ICUs from a university hospital from July 2014 to February 2015 as well as via the Internet, a panel of 1,050 participants who had recently experienced ICUs. The analysis shows that:

50 to 70% of the family members of a patient in the ICU hesitated to express their concerns about the situations or decisions of care in particular on the safety aspect;
The fear of being called a “troublemaker”, of not knowing whom to turn to, and relentless treatment are the reasons most frequently given to explain this hesitation;
On the other hand, on other less “compromising” subjects, including drug prescriptions, nearly two-thirds of patients and their families say they feel very comfortable expressing themselves;
but only a third of respondents dare to express a concern about hand hygiene or a disagreement, with the healthcare team, about an attitude of their hospitalized loved one (aggressiveness of the patient, for example).

Oral expression is a key element of the culture of safety : yet the study reveals a difficulty for the majority of patients and their families to speak during an ICU stay. Yet, in such a critical care setting, families may hold valuable information for clinicians. They are also often the first to detect a change in the patient's clinical condition. Families should therefore be encouraged to voice their concerns.

These results underline the need to explicitly help patients and families to express themselves in real time, including on "perceived errors", which could improve the safety of care, note the authors. Giving patients and their families a voice is a relatively inexpensive intervention that could significantly improve patient and family outcomes.

" Ensuring that clinicians listen to patients and families when they speak can also help ," the researchers suggest.

Classification of non-cases are curable .. Infectious diseases without treatment. Sick patients in the intensive care unit and people with severe neurological diseases led to their total disability

This topic was discussed at the Islamic Fiqh Academy in its previous session in Jeddah (1412H) and issued the following decision:
"(A) It is necessary for the Muslim belief that sickness and healing is in the hands of God Almighty, and that medication and treatment are the reasons that Allaah has placed in the universe, and that it is not permissible to despair of the spirit of God or despair of his mercy. In caring for and relieving his or her psychological and physical suffering regardless of whether or not he expects recovery.
(B) What is regarded as a hopeless condition of treatment is, according to the doctors' assessment, the potential of medicine available at any time, place and according to the conditions of the disease. "
Accordingly, the Islamic Jurisprudence Academy has left the appreciation of these cases to doctors and the available medical possibilities.
Incurable cases include many cases involving:
First: Patients with incurable diseases and no treatment and known as the gradual aggravation that ends in death near or far. For example, a widespread, untreated cancer, which is medically known from similar cases, will end in death within months.
Second: Patients who are in the intensive care unit and who have failed with all the means of treatment available to improve their health, they ended up in a semi-final state. They are closer to death than they are to life and are dying. For example, a patient with severe sepsis in the blood, who did not use artificial respiration, dialysis and various medications to stop the development of the disease (this is called medically the case of multiple organ failure).
Thirdly, patients with severe neurological diseases, which resulted in their complete inability to intellectually medically hope for improvement. An example of this is the Sheikh of the pyramid who is severely demented in a manner that is unknown to those around him, unable to perform his needs and does not control urine and feces.
Fourth: Patients with persistent plant conditions, which means the injury of the cerebral cortex permanent permanent injury with some functions of the brain stem intact. Such a patient in a complete absence of consciousness and awareness, but he breathes and digests food and opens his eyes and closes them and therefore he lives a life closer to the life of the plant to human life. Such cases are seen in some accident victims.
The concept of incurable cases does not include brain death. Brain death is defined as the disruption of all functions of the brain irreversibly and irreversibly. The ruling of this patient - as decided by the Islamic Fiqh Academy - the ruling of the deceased. The discussion of this case is beyond the scope of this research.

Directories used to determine that the patient has an incurable condition .. Some types of treatment-resistant leukemia end in death within four to six months

Doctors report that the condition is not curable for what is known as medically similar cases. They also rely on their personal experiences in this field. For example, some resistant cancer cells end up dying within four to six months. The doctor therefore determines that the patient's condition is expected to have a similar fate.
It is clear that such an opinion is based on the assumption of certainty and it is impossible to confirm it in a certain manner. Accordingly, such estimates may be subject to error.
In order to reduce the possibility of this error, the fatwa issued by the Standing Committee for Scientific Research and Ifta issued on 3/6/1409 e required that the case of non-recoverable three doctors competent specialists. This condition was adopted by a number of major hospitals, including the internal administrative policy of King Fahad National Guard Hospital on 5/9/1420 AH, as well as the guide for health practitioners on the ethics of the medical profession issued by the Saudi Commission for Health Specialties.
Although the requirement of a three-consultant agreement reduces the chances of a false expectation of incurable cases, it does not deny it at all.

The definition of intensive care and its capabilities.. Excessive fatigue and strain on the patient to develop breathing tubes, nutrition, urine and intravenous nutrition

What is Intensive Care and what are its capabilities?
Intensive care is defined as part of the hospital where there are enough nursing and medical personnel and accurate monitoring devices to monitor the patient in a precise and continuous manner, in which microbiological treatments such as artificial respiration, blood pressure medications and others can be offered.
In this regard, the following points should be taken into account:
1. The expected benefit of hypnosis in intensive care varies greatly depending on the patient's condition. A young patient with severe asthma is expected to benefit greatly from intensive care. This means that the patient's hypnotism in intensive care usually ends in healing and returning to normal, and that deprivation of it may end with his death. While it is expected that the benefit of a large elderly patient with malignancies, kidney failure, skin ulcers and blood poisoning is much less. This is likely to mean that such a patient will die despite all the treatments provided, and that if he improves, such improvement is likely to be only temporary and does not lead to return to normal.
2. Intensive care is very expensive given the equipment and equipment and the cost of the staff. In some hospitals, such as the King Fahd National Guard Hospital in Riyadh - where a nurse or nurse supervises one patient, a room in intensive care needs to employ five nurses. Some studies estimate that intensive care units in hospitals consume up to 30% of the hospital budget.
3. Due to the scarcity of specialized staff and high cost, the number of intensive care beds in any hospital is limited. The number of patients requiring intensive care services is often greater than the available capacity. How many patients in critical need of intensive care waiting in the emergency department, and how a patient in a serious condition is treated in a hospital in a way that is not commensurate with the seriousness of his condition is expected to have a bed in the appropriate hospital, but to no avail, and how many patients postponed his surgery days Or weeks because there is no bed in the ICU, resulting in serious risk.
4. More complicated is the fact that fewer or more beds of intensive care are occupied by patients with incurable conditions, depriving others who are relieved of this important service. In one hospital, I saw more than a third of the intensive care beds busy with patients with severe, uncooperative injuries, and one had been in intensive care for more than 10 years. It is no secret of the waste of public funds of Muslims.
5. Treatment in intensive care is a great strain on the patient. An intensive care patient needs breathing tubes, nutrition, urine and intravenous nutrition. Artificial respiration is also accompanied by great difficulty due to the pressure of the air from the breathing apparatus inside the chest, not to mention that the patient is often away from his family and mixed with the night and day. These should be taken into account in the case of a patient with a condition that is not to be cured and to determine if the short-term benefit of intensive care in such patients justifies such hardship for the patient in his or her death.

The role of the doctor in intensive care.. Providing medical assistance to the individual patient as an individual. The use of intensive care resources optimally so as to provide the best services to the total patients

The ICU has two responsibilities that may sometimes conflict:
First: The doctor is entrusted to provide medical assistance to the patient as an individual.
Second: The doctor is entrusted with the use of intensive care resources to provide the best services to the total patients.
The inconsistency between these two responsibilities lies in the fact that the doctor oversees the unlimited provision of services to an incurable patient, which leads to the enrichment of these services and depriving others of them. For example, a severely curable cirrhosis patient with severe bleeding requires blood transfusion in very large amounts that may consume most of the blood bank, depriving others who may need a small amount to save their lives as accident patients.
The same applies to a patient who can not be healed to the only remaining bed in the intensive care unit, and that is denied to another patient whose chances of healing may be great if he is given proper treatment.
A number of ICUs have decided that "patients with terminal illnesses are not likely to be cured and are unlikely to benefit from intensive care. They should not be admitted to intensive care departments."

Cardiopulmonary resuscitation.. Place an oral tube into the lungs and help the heart by repeatedly pressing the chest with medication

Doctors resort to heart failure to do so called CPR. This usually involves calling a full medical team quickly and then doing breathing assistance by placing an oral tube to the lungs and helping the heart by repeatedly pressing the chest with different medications. Electric shocks or pacemakers may be used.
This recovery is very important in patients who have been in good health prior to cardiac arrest and then have had an emergency and have stopped the heart. For example, a 50-year-old man has a heart attack that has stopped his heart. Such a patient is expected to respond to CPR.
In other cases, when the patient has multiple organ failure, the recovery benefit may be much lower, so that in some cases the recovery benefit is close to zero. For example, an intensive care patient on respirators, dialysis and severe hypotension despite multiple blood pressure medications, the patient's response to recovery is virtually nonexistent.
It is no secret that the recovery is a great hardship on the patient's body and such hardship justified if it will save his life. If the recovery is useless and ends with the death of the patient, does it justify resuscitation at the same time, leading to hardship for the dying patient such as repeated electrical shocks?

Dealing with the patient and his family .. Give them the appropriate medical information to accommodate them and take into consideration the graduality of giving bad news

1. It is the duty of the doctor to respect the patient no matter what degree of illness. And that the fee is calculated to alleviate it, the ICU is in a great generosity.
2 - It is the duty of the doctor to give appropriate medical information to the patient and his family to the extent of absorption and take into account the gradual in giving bad news.
3 - The opinion may differ between doctors and parents about cases that can not be cured and the parents insist on providing all treatments, despite the opinion of doctors that it is useless.
This is a thorny issue that needs to be considered by scholars of Islamic law.
The opinion of the doctors in this is that the provision of treatment is a medical issue decided by the specialists, and if the specialists decide the reliability of the futility should not be given regardless of the opinion of relatives of the patient.

Questions raised by the medical community to Islamic scholars about the incurable cases .. Pain relief for a patient with advanced cancer and severe pain in the bones

Questions raised by the people of medicine to scholars of Islamic law about the incurable cases:
1 - What is the legitimate ruling in providing CPR or not to the patient who is in incurable condition as a cancer patient spread, which can not be treated when heart failure and breathing.
2 - a patient of a pyramid with severe dementia who can not identify those around him suffered severe inflammation of the lungs. The doctors have decided to treat it with antibiotics, intravenous fluids, oxygen and other possible treatments in hospital suites. They also determined that if his health deteriorated to the point where he needed intensive care, he would not be transferred there while continuing with other treatments. Cardiopulmonary resuscitation will not be performed if the heart is stopped. What is the ruling on sharee'ah in such a case?
3 - a patient entered intensive care because of poisoning in the blood and was given intensive treatments including antibiotics and artificial respiration and others, and then discovered that he has a cancer spread in the lungs and continued to deteriorate and reached the extent that doctors decided that the opportunity to respond to treatment is almost nonexistent. What is the ruling on stopping treatment in such a situation?
4- If the ICU is referred to two patients at once: The first is a woman with six children who suffered a severe postpartum haemorrhage requiring intensive care and the second an elderly man who has been in a position for two years due to paralysis in his right side and is unable to speak He had acute pneumonia and needed intensive care. The problem is that there is one bed available in intensive care and there is no chance to open any other bed or to move any patient to anywhere else. On what basis should the doctor build his decision?
5 - An elderly patient has been in a seat for four years as a result of a large stroke that left him with permanent paralysis and inability to speak and to identify those around him. He is also unable to serve himself by eating or controlling urine and feces. He was admitted to the hospital as a result of a heart clot. The doctors determined that his condition was not curable and that he would not give him CPR in case of cardiac arrest and would not enter intensive care if his condition deteriorated. However, the family of the patient rejected this decision categorically and insisted on the introduction of the intensive care unit and give him all the possible treatments some consideration of anything else. What is the shar'i ruling in such a case?
6 - a patient with advanced cancer and suffering pain in the bone and doctors decided to relieve pain needs to give large doses of morphine. It is known that such doses may lead to slow breathing and may accelerate death. What is the ruling on sharee'ah in such treatment?

Intensive Care Unit.. Provide the highest types of therapeutic interventions, saving, fast and specialized. • Continuous and efficient monitoring of critical and hazardous conditions

Intensive Care Unit:
An independent stand-alone suite is located close to the operating theaters, emergency, radiology, lab, rest rooms and other basic services, ensuring smooth movement. Emergency medical teams can also access and respond to emergency calls for as little time as possible.
The Division provides the highest types of preventive, quick, specialized and highly efficient treatment interventions, as well as the continuous and efficient monitoring of critical and hazardous conditions to sustain the functioning of various functions and organs of the body and the treatment of mixing in the event of its occurrence and to remove it from the condition that passes through the symmetry To heal and stabilize his health and physical condition.

High Dependency Unit.. Monitoring and therapeutic interventions, including the rehabilitation and maintenance of one device for the patient does not require an artificial respirator

High Dependency Unit:
An independent suite is located close to the operating theaters, emergency, laboratory, radiology and other departments and other basic services to ensure the smooth flow of traffic between them and performs advanced care services between intensive care and anesthesia, including monitoring and therapeutic interventions, including the rehabilitation and maintenance of one device for the patient and does not require an artificial respirator And works to address the mixing in the event of occurrence and to get the patient out of critical condition towards the similarity of full recovery.
Its critical staff is a trained specialist in the care and control of high efficiency and the preparation of nurses in it is less than the people of intensive care and their equipment is the same as the intensive care equipment except pulmonary resuscitation as well as its engineering and functional description is similar to the people of intensive care.

Critical condition.. The pathogenesis of the failure of one or more vital organs to perform its functions in an ideal and systematic manner

Critical condition:
Illnesses caused by the failure of one or more vital organs to function optimally and systematically The causes may be known or sometimes unknown. They also include postoperative and major postoperative conditions that need to be monitored or maintained for one or more vital organs and are divided Critical status to the following stages:
The second phase: which needs to be revitalized, monitored and maintained for one device and this needs the care unit.
B - Stage III: which needs to revive and maintain and control of the respiratory system with at least two vital organs.
C - Stage I: which needs to monitor and follow-up to the cases of disease after the exit from the second and third phase to be under the supervision of (outreach team) composed of a resident resident resident intensive care and nurse number two intensive care and highly trained.

Engineering characterization and functional branches of intensive care .. Store to replace and keep sheets, clothes and utensils sterile and non sterile

The intensive care people require a special vacuum and considerations for the equipment needed for the staff to perform the active and urgent functions:
• The area of intensive care is determined according to the number of beds, which are determined according to their proportion to the ratio of the number of hospital beds which is not less than (10%) of the hospital beds.
• Its walls and floor are of glaze type to reduce the growth and spread of germs.
• The optimal patient bed area is 16-20 square meters, a bed distance between the bed and the vertical wall of not less than 0.9 meters, and a minimum of a passageway at the end of the bed with a minimum of 1.2 meters. Without obstructing the movement of the family and equipment, and there are separations between the beds of patients in the case of not using the methods of single rooms and private and have measures to maintain the confidentiality of accidental viewing that may be located by patients and other visitors as well as noise Each bed has an optical link (window) The distance from the patient's bed to the window should not exceed 5 m.
• There should be special rooms for patients who need complete isolation from the rest of the patients.
• A special button should be provided to call the nursing staff for each bed to request assistance. The unit's pager should include contact measures with a digital emergency code and recovery alarm as well as call for assistance from outside the Division with at least six electrical points per bed in the lobby, Of oxygen exits, 1 outlet for compressed air and 1 outlet for fluid withdrawal per bed.
• Special wheel for safe storage of patient's medical equipment.
• Reception station for patients at the beginning of intensive care with special offices and a place to replace the appendage clothing.
• A nursing station with a location and a space for observation and observation to enable them to visually monitor all patients and contain the necessary equipment and equipped with a loud / low sound alarm and the ability to give a copy of the forms of waves required to care for patients.
• There should be a handwashing area for owners near the nursing station and patient beds areas with at least one washbasin for every two beds of patients with service spaces within each intensive care ward with easily accessible toilets for wheelchair users Patients with at least one toilet for every four beds.
• Administrative offices according to staff specialization.
• Break rooms for employees in this division according to their specialties and work schedules with the availability of special cupboards for the preservation of personal objects with bathrooms and toilets.
• Dining room for staff in the Division.
• Replacement room for functional staff.
• Store to replace and store sheets, sterile and non-sterile clothes and utensils.
• A room for collecting sheets and used clothes.
• A cavity chamber dedicated to storing equipment used to care for patients and storage areas should not interfere with flow and traffic.
• Small room for cleaning and cleaning equipment.
• Clean room for nutrition, preparing food for patients or storing ready-made oral food with refrigerators to store clean food items with food preparation tools, cabinets to store sterile utensils and distribution of food supplies.
• Room and store for pharmacy and medical supplies with a unit for the disbursement of medicines and supplies.
• Laboratory for urgent analysis such as: Blood Gas Analysis, Blood Urea, Electrolytes
• A small operations hall for specific cases, if there is no operating room close to the Division.
• Room for the maintenance, maintenance and sterilization of medical devices and equipment.
• A room adjacent to the division is reserved for visitors.
• Office or private room adjacent to the Division to consult with intensive care contact.
• A room or hall adjacent to the division dedicated to meetings and deliberation, giving lectures and training and educational courses.
• A storage room for conveyors and wheelchairs is adjacent to the Division.
• The ventilation of the Division in terms of the degree of cooling and heating (16-27 ° C) with moisture ranging from (20-25%) with the use of isolation methods.
• Provide fire safety and control.
• Provides lighting and a source of backup power.
• Use complete isolation methods and prevent acquired infections.
• Centralized oxygen at a rate of 20 L / min & 4 bar at each bed.
• Pull the central fluid by 500 mm Hg
(66.6 kpa atmospheric pressure and 40 L / min. At each bed).

Structure of intensive care.. Technical Unit. Support Unit. Administration. Qualified and trained staffs with a high level of competence and experience

Be at the division level and include the following units:
1- Technical Unit: which deals with medical and nursing care for the ICU auditors.
2- Supporting Unit: It consists of:
Management - Laboratory - Physiotherapy - Nutrition - Maintenance and maintenance of medical devices - Operations hall in the absence of an operating room close to the Division - Trauma Team - Team Out - reach team.
3. Management.
Working staff: Qualified and trained staff with a high level of competence and experience covering the work during the period (24) hours full work consists of:
• An anesthesiologist and intensive care (1) per bed.
• Senior resident doctor for each bed and number of beds in the division.
• Intensive care nurse (6-7) per bed.
• Technical staff of medical devices (1) per bed.
• Normal processor number (1) for each (5) beds.
• One clinical pharmacist, one pharmacist assistant for each (5) beds.
• Competence of feeding one number of the Division with a medical assistant number (2) for the Division.
• Laboratory staff number (5-7) for the Division.
• Processor pronunciation number (1-2) of the Division.
• Professional Wizard Occ Therapist number (1-2) for the Division.
• One serving tank for every two beds and each meal.

Medical devices in intensive care .. Blood and fluid delivery apparatus. Intravenous and arterial catheterization. Direct arterial pressure measurement. ECG scans

medical equipments:

1 - Electric bed with multiple movements with vibrating air mattress and sand bed according to the needs of the Division.

2 - Multifunctional monitoring devices for each bed linked to a central control system, containing at least 30% reserve:

• NIBP - Non-Invasive bl. Pr

• ECG monitor

• SpO2 - Saturation PO2

• ETCO2 - End Tidal CO2

It should also include:

• PICCO - Pulse Induced Cardiac Contour output.

• BIS (Bispectral Index scale).

• One Ventilator ventilator for each bed and a reserve of at least 30% of the total number of beds.

• Cardiac shock absorber D.C Shock One number per bed.

• One heart layout device.

• A fluid withdrawal device for each bed.

• Syringe Pump & Infusion Pump for four syringes.

• Low & high Pr. Reducing valve One number per bed with a reserve (30%) of the total number of beds. In the absence of central oxygen, three organizations are placed for each bed with 30% reserve.

• Patient heating system (25%) of beds.

• Other accessories and equipment: Artificial respirators with cardiac monometers, portable hand-held respirators, tracheal braces, surgical tools, surgical instruments, tracheotomy (2-3 trolleys) with trolley to other sections to complete or use patient tests In other lounges until a patient's bed is set up in the Emergency Cart.

• Electric Nebulizer.

• Mobile X-ray, Mobile Sonar, Echo device.

• Blood dial machine number (2-3) for the Division.

• One optical fiber optical sighting device.

• Plasmapheresis number one for the Division.

• A pressure gauge and a thermometer from the ear with a doctor's earpiece,

• Laboratory devices for the necessary laboratory tests: Spectrophotometer, ABL or ABG, Glucometer, microscope, water distillation device.

• Physiotherapy equipment.

• Special blood storage refrigerator with emergency bed.

• Feeder strap (2) per bed.

• A protective container for each bed (Apron).

• Ambu Bag One number per bed with back-up storage.

• Medicines and medical supplies:

Blood and blood flow apparatus, blood and blood acceleration devices, blood warmers, suction and fluid suction devices, tracheal tubes and various measurements, intravenous and arterial catheter kits, Invasive BP, central cannulas, , Catheters, Syringes, Catheters, Syringes, Nutrients, Intravenous Feedings, Emergency and Recovery Medications, Anesthetics and Trauma Medications , Medicines.

Duties of the Intensive Care Division .. Critical conditions before and after multiple operations or injuries, respiratory disabilities, non-treatable drugs, and therapeutic and diagnostic interventions

Duties of ICU:
Receiving patients with certain critical conditions before and after the operations or multiple injuries, respiratory disabilities, non-medicable and therapeutic and diagnostic interventions, which require the following:
(A) Monitoring of ongoing vital events;
B - assigning the vital activities of the patient to the drug and the competent bodies.
Treatment of mixing when it occurs.
(D) Keeping the patient's condition physiologically closer to the normal state and until the causes of the deterioration of the health condition have ceased.

The mechanism of dealing with the patient and the work context in the ICU .. Monitoring and documenting vital events according to the special forms for this purpose and attached to the file of the deceased patient

The mechanism of dealing with the patient and the work context in the ICU:
1. The patient must enter the ICU according to a special consultation and referral form by the competent doctor, in which all the information related to the condition and after contact with the ICU are recorded and indicated at the main information center.
2. The doctor shall determine the patient's condition and acceptance in the lobby and determine the necessary interventions for treatment, documentation and confirmation of his observations and recommendations to the working group. With each according to its competence in two forms with two copies, one of which is kept in the file of the deceased patient.
3 - Transfer the patient to the lobby under the supervision of the medical team and the nursing staff (outreach team) and in accordance with the instructions of safe transport of the patient with the preparation of all requirements.
4 - Nursing staff working in the lobby to create the bed allocated to the patient and in accordance with the instructions of the doctor's specialty and work to receive and help the patient and prepare the file of the deceased patient and record the patient's initial data.
5 - The resident doctor periodic and older complete the process of medical documentation and record their medical and clinical observations and tests and vital signs, etc., and in accordance with the directions of the doctor's specialty and guide the nursing and nursing staff and according to the health status of the patient.
6. Inform the patient's parents of the results of the consultation and the patient's condition before and during his leg in a calm manner, reassuring them that he is in safe hands and tell them the development of the disease and health throughout his period.
7 - The vital events are monitored and documented according to the special forms for this purpose attached to the file of the deceased patient and the treatment given to him and the results of laboratory tests and support according to the directions of the physician, the specialist, the physician, the anesthesiologist and the intensive care by the medical, nursing and technical staff. Prepare tables and confirm the results of their visits and recommendations.
8- The specialist doctor, the anesthesiologist and the intensive care physician shall prepare a treatment plan according to the approved medical protocols in the health institution based on scientific and scientific evidence approved in the file of the deceased patient, specifying the duty of each member of the medical and nursing staff working in the lobby or Division.
9 - Working in the Division is done in a system of meals and 24 hours full (three meals and prevents sleep for all members of the working group during the working meal).
10 - The clinical pharmacist document the treatment and dialogue with the medical team treated to the patient on the treatment and placed in a wheel for the patient is kept in small containers in which the name of the patient and the full name of the physician and the number of his bed and file and follow any drug interaction or sensitivity, etc. and prove this in the file The patient lies and informs the therapist.
11. The nursing staff shall monitor the patient and confirm his / her observations in their form in a complete and clear manner.
12 - Nursing and administrative staff to meet the needs of the patient pastoral and hotel.
13. The commitment of all members of the working group in the unit to the ethics of the profession and humanitarian dealings with the patient and their families.
14- Implementing the programs of controlling acquired infections, preserving the environment, isolating waste and means of personal protection, and maintaining the cleanliness of the hall and its assets.
15 - The obligation of the owners working in the lobby in the uniform determined and without any exception.
16. The entry of auditors and escorts shall not be allowed to the lobby or the division.
17. The validity of discharge of the patient from the Division by the treating physician (specialization) during the official working hours and after the official working hours by the senior resident doctor and in coordination with the doctor, the specialist is documented in the file of the deceased patient and organize an exit card for this purpose with a brief report on the situation, Pathology and health, and the need to stay in intensive care.
18. Nursing staff shall keep the file of the patient lying in a special wheel to be delivered later to the hospital statistics with all notes written.
19. The nursing staff working in the lobby shall organize and keep the records of the lobby intact and keep them clean and organized.
20 - the specialist doctor to follow the needs of the lobby assisted by the medical team and nursing and technical assistant and provide and keep the Division ready and throughout the day.
21 - The specialist doctor responsible lobby:
A - Periodic review of deaths and referrals in the unit and discuss the negatives and positives with the working group in the lobby and documenting that activity with treatments.
(B) A consistent policy for the level of care provided to patients on a regular basis and ways of developing them and evaluating the staff of the Division.
(C) a schedule of scientific activities, training courses, etc.
(D) Develop a consistent policy for the periodic maintenance and maintenance of medical devices and equipment.
C) Introducing the IT system at work.
H. Policy on infection control, pollution control, sterilization and immunization of staff in the Division.
X - focus on medical documentation and nursing .. Etc. and away from abbreviations and attention to writing in clear and in a way understandable and simple and maintain the file of the patient lying.
Supervising the follow-up of the wheel of shock.

Qualifications, duties and powers of the ICU official.. Develop plans and train senior and senior resident physicians and nursing staff

• Qualifications:
1- Specialist doctor or consultant anesthesia and intensive care.
2- Has scientific experience, good administrative efficiency and good social personality.
3 - Has knowledge and experience with the concepts of safety and safety of the patient and the concepts of quality.
• His duties and powers:
1 - manages and directs all the work of the technical unit and administrative support and ensure the safety and safety of the patient and the application of quality standards and ethical and professional standards.
2 - Setting up and follow-up schedules of work and the commitment of all the staff of specialists doctors and senior resident physicians, etc. in the Division and ensure the delivery of an integrated service and over (24) hours full and recommend the reward of excellence and accountability of the default and in accordance with the practices and ethics of the profession.
3 - Inspection and examination and guidance and provide advice to patients reviewing and writing treatment and laboratory tests and Radiology necessary and follow-up and carry out visits and documentation of those activities and follow-up medical documentation and records of the Division and follow the position of devices and equipment and medical supplies and medicines .. And with the help of related persons.
4 - Participation in the development and formulation of policies for the development of treatment services in the Division in particular and the hospital in general.
5 - to prepare plans and training senior resident doctors and periodic and nursing staff working with him or assigned to work with him in all corridors and consultants and involve them in the scientific, technical and administrative activities, evaluation and guidance and follow-up regularity of their time.
6. Supervise all medical and health programs applied in the control of acquired infections, treatment of medical and non-medical waste, pollution and hygiene, health awareness, supervision and participation in the committees formed in the hospital, if mandated by the hospital administration and follow-up rational use of the drug.
7 - Has the authority to transfer the patient to another hall in the hospital (for a brother) or another hospital for the purpose of completing the treatment and improve the health and medical status of the patient (and that necessary scientific, medical and health) and with the knowledge and approval of the Director of the Department and management of the hospital and documented it in writing (his name and signature and stamp) The senior resident and the nursing staff and explain the cause of the procedure for the patient or his family.
8. Participation in meetings and medical lectures (continuing medical education) to ensure the raising of scientific, professional and technical level and participation in major clinical tours.
9 - Referral of suspected deaths to the forensic medicine and in accordance with the laws and procedures approved and with the knowledge and approval of the director of the hospital and the head of the department.
10 - Assisting new graduates of the specialized doctors working in the lobby and supervising them and assist them in the case of assignment of this duty by the hospital administration and the head of the department.
11 - Doctors consult the specialty of the same branch or other branches in the case where it is necessary to indicate their advice and access to the healing of the patient and improve the medical and health situation and documenting it in writing.
12 - Commitment to the official time and schedules prepared by the management of the hospital and the head of the department or the duties and tasks assigned by them.

The duties and functions of the staff in the lobby of the intensive care .. Doctor Specialty. Senior resident or league resident. Nursing Officer in Division. The nurse

A - Duties of the specialist working in the lobby:
Are the same duties and duties of the specialist and within the jurisdiction and place of work.
B - duties and duties of the senior resident doctor working in the lobby:
Are the same duties and duties of the senior resident doctor within the jurisdiction of the branch and place of work.
The duties and duties of the resident resident doctor in the lobby:
Are the same duties and duties of the resident resident doctor in the lobby and within the workplace.
D- Qualifications, duties and duties of the Nursing Officer in the Division:
• Qualifications: A graduate of a nursing college, technical college, medical or technical medical institute with experience and scientific competence in nursing and working in intensive care people, preferably in intensive care courses.
• Tasks and duties:
1 - Receiving the directives of the senior management of the hospital and the department and work on its implementation and follow-up.
2. Receiving the directions of the ICU (Specialist Physician).
3- Receiving the directives of the Nursing Affairs Office.
4 - Distribution of owners and meals to the patients who are asleep.
5 - Prepare a monthly schedule of morning and evening meals for nursing staff working in the Division.
6 - processing the Division and its halls and work to follow up with medical supplies and general materials.
7. Confirm the record of receipt and delivery of duties.
8. Assure duty officers to report monthly on the work of their duties.
9- Record the presence and departure of the Division's employees.
10 - Emphasize the cleanliness of the section and the weekly fainting and the isolation of medical waste for non-medical and pollution control.
11 - Work a record of the statistician to enter and exit patients who are asleep and indicate their health.
12. Coordination with the Medical Devices Division for the provision and maintenance of medical devices for deceased patients.
13 - the number of bulletin boards include the names of patients and doctors, and the traps and nursing and nursing.
14- Preparing educational and scientific courses for nursing staff.
15 - Supervising and follow-up on the distribution and giving treatment and food and provide the patient's sleeping belongings and follow-up file of the deceased patient and documentation of nursing staff for their observations and visits.
16- Recommending thanking books for distinguished persons and penalties for those who are short of nursing and nursing staff and refer to them in the case of workshops, seminars, etc. to nominate candidates.
Functions and duties of the nurse working in the ICU:
Is the same as the duties of the nurse working in hospital lobbies and within the limits of his competence and place of work.

Shock Team in intensive care.. Recovery and transfer of critical patient carefully and quickly and in an easy way to maintain vital events

Shock Team:
Specialized medical team with high experience and efficiency in the recovery and transfer of the critical patient carefully and quickly and in an easy way to maintain the vital events, which consists of a resident resident anesthesia and intensive care with a nurse number two with a transport vehicle component is trained and working under the umbrella of a specialist doctor and transfer patients from the hospital To the Intensive Care Division with safe means of communication and equipped with medicines and special supplies for that purpose.

Clinical Pharmacy Officer in ICU.. Ensure the date of expiry of the drugs and the absence of physical changes and to report in case of occurrence

Clinical Pharmacy Officer:
• Qualifications: A clinical pharmacist who is a participant in clinical pharmacy courses at a minimum, with good scientific experience, competence and personality.
• Duties:
1- Participating and adhering to the policies and plans of the pharmaceutical and therapeutic services and programs of improving and evaluating the performance according to the quality systems and ethical standards of the health institution and taking into account the conditions of safety and safety of the patient in providing the service.
2. Participate in the clinical morning tour of patients who have been discharged and clinical medical supervision to distribute Dose System unit and the possibility of adopting the principle of pharmacological equivalence in the determination of their high toxicity and follow-up treatment in the correct and specified time, Pathological and follow-up sensations and therapeutic and pharmacological complications of the patient with the medical team, nursing and health and work to address them.
3- Organizing and marking the clinical pharmacological treatment form for each patient who is in his file and the special records for that purpose in accordance with the prescribed treatment and confirming the order of medicines and matching them with the files of sick patients who have fallen from Western medical prescriptions.
4 - to ascertain the date of expiry of drugs and the absence of physical changes and to report in case of occurrence as well as side effects and the return of drugs remaining and unused to the internal pharmacy and in accordance with the established regulations.
5. To educate patients and respond to their inquiries and to raise awareness among health workers in a scientific and exemplary manner about the medicine and its guidelines to prevent complications, misuse and waste.
6 - Participation in scientific activities, discussions and training courses and work on the development of work in the Division.
7 - Commitment to the hall's uniforms and instructions to control pollution and reduce acquired infections.

Cilveducation

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