Intensive Care Unit / High Dependency Unit (HDU)

All the staff working on this unit are dedicated to providing quality healthcare service. We will provide care in such a way as to respect the dignity, privacy and confidentiality of each patient and his or her family. We aim to treat each patient as an individual and act as the patient’s advocate, in conjunction with family and significant others. At Hamida Ashiq Trust Hospital’s Intensive Care unit ensures the cover of Consultants from all specialties, Post Graduate Trainees, Medical Officers, Intensive care trained Nurses, Caregivers and dedicated support staff.  The Intensive care is equipped with multiple parameter patient monitors, Infusion pumps, Ventilators, C-Pap, Central Oxygen and Air Supply, Suction, Defibulators, ECG, Portable X-Rays, Portable Ultrasound and Doppler facility, ABG’s and other laboratory based test facility on Urgent basis. The Intensive Care Unit maintains a supply of medicines and essential supplies. All Life saving gadgets are connected to a UPS and backed up by 300% Backup power generators. Admission to the Intensive Care Unit (ICU)/ High Dependency Unit (HDU) A patient whose condition is extremely serious, possibly life-threatening, is often taken to an Intensive Care Unit which provides constant observation and treatment from specially trained staff qualified to use specialised equipment. Some admissions to the Intensive Care Unit are planned, usually after major surgery or in order for specialist treatments to be performed. In such cases it may be possible to visit the unit beforehand or receive an information book. This can help you and your relative or friend by showing you the environment of an Intensive Care Unit in advance. However, most admissions are in emergency situations. This unit is a combined ICU and High Dependency Unit (HDU). HDUs are for patients who require less monitoring or treatment than is normally provided in an ICU. Due to clinical need, men and women are nursed next to each other on the unit the staff will endeavour to maintain your relative’s or friend’s dignity at all times.When your relative or friend is discharged they will either go to a private room/Ward. Technology in the Intensive Care Unit The Intensive Care Unit uses machines which can look frightening when seen for the first time. These machines help us to monitor and support a patient’s normal body functions. Each patient is attached to a machine called a cardiac monitor. Small, sticky pads are placed on the patient’s chest and are connected to a machine. The machine picks up electrical impulses from a patient’s heart and can detect any abnormalities. The monitor can also show a patient’s blood pressure and temperature. It is normal for the numbers on the monitor to keep changing. A patient who is not strong enough to breathe on their own will be connected to a ventilator (breathing machine). This is attached to a tube passing through the nose or mouth into the windpipe. The tube, which is known as an endotracheal tube (ETT), is connected to a machine that blows air and extra oxygen in and out of the lungs. The machine can ‘breathe’ completely for a patient or it can be set to assist a patient’s own breathing. A patient can be gradually weaned off a ventilator when their condition improves. If a patient is likely to remain on a ventilator for more than a few days, the endotracheal tube (ETT) is sometimes replaced with a tracheostomy. In this case an operation is carried out to insert a tube into a hole made in the throat. Although this can look quite strange, it is actually more comfortable for the patient than having a tube in their mouth. Please remember that, although unable to speak, your relative or friend may be able to hear you. By all means do talk to them, but questions should be put so that they can be answered with a nod or shake of their head. Patients are often attached to drips or infusions. These allow liquids to be passed through tubes into veins, usually in the side of the neck, arm or hand. There are various substances commonly used in drips. Fluids can be used for various reasons including re-hydration and maintenance of blood pressure. A pump is attached to the drip to administer the drugs at the correct rate. Food in the form of liquid containing essential nutrients can be given either through the nose via a tube which goes down into the stomach, or by using a drip. Your relative or friend will have a urinary catheter in order to empty their bladder. We measure the urine every hour so that we can assess how the kidneys are working. Many of the machines have alarms and flashing lights. They go off quite often for a variety of reasons.  The ICU staff in attendance shall be monitoring these very closely. Can I help? You will be required to ensure steady supply of medications needed during the course of treatment in Intensive care unit this you can do by contacting the Pharmacy. There may be a need to give Blood or blood products to your patient. Availability of the same can be ensured through the Blood bank or through a Fresh Donor blood volunteered by the Family. Some of the drugs will keep a patient deeply asleep. However, you should always assume that the patient can hear you and understand everything that you are saying. Do feel free to talk to your relative or friend. Do not be afraid to touch your relative or friend. It may be comforting for both of you. Treatment/ Procedural Consent: The Hospital seeks your consent for treatment at every stage of the treatment process whether it pertains to Life Saving Treatment, Ventilator support, Do not resuscitate protocol, Invasive diagnostic procedure etc. Policy for Consent: Hamida Ashiq Trust Hospital has made available a copy of Patient Rights & Education at all entry points of the hospital. The general consent is necessary while a patient seeks treatment in outpatient department, accident & emergency department & consultant OPD’s. Every prescription generated in the hospital will have the general consent of the patient on the footer of the prescription as evidence, which needn’t be signed by the patient. Uniform Cost of Services: The charges for OPD and Consultant Clinics are clearly printed and displayed in relevant departments for information of patients and their attendants. To implement the uniform policy of cost of treatment for all, a standard rate list is available at the front desk and patient facilitation center. For companies and panel cases, discounted/subsidized rates are mutually agreed upon between the service provider and the client. This may be higher or lower than the prescribed rates for private patients. Please see rates on Notice Boards. Informing Patient’s of Treatment Costs: The hospital has a policy of taking partial advance payments from patients to assure that they understand and fully co-operate with the hospital with rest to their financial obligations. It’s the responsibility of the front desk staff and customer facilitation center staff to inform, educate & counsel the family on treatment costs. In case of change in patient’s condition/complication, it’s the responsibility of the management, consultant or front desk to intimate patients and their attendants from time to time. The Complaint System: The hospital has a system of collecting, prioritizing, reporting & investigating of complaints. The hospital keeps a record of all complaints whether verbal or written, in the complaints register which is available at the patient facilitation center. It’s reviewed on a daily basis by the management and support team and addressed. Necessary actions needed are taken and patient making the complaint is informed of the outcome/redressal of the complaint. While handling complaints, it’s important to differentiate between allegations and actual nature of complaint. The investigator should remain impartial & all complaints need to be addressed in a specified timeframe irrespective of the allegation or nature of complaint the complaint officer has to remain firm, unbiased and polite towards patients & their attendants. Monitoring the complaints, investigations & suggestions for improvement in process quality to avoid such complaints is a necessary part of all management review meetings taking place on regular intervals. All healthcare professional must ask themselves this question what sort of consent will keep us covered- Even if the treatment is free. Types of Consents:

• General Consent: For all consultations; General consent for Prescription and Treatment on OPD form. (Footer of ALL Prescriptions & OPD Slips)
• Anesthesia Consent: Anesthesia assessment and Consent (Pink Form)
• Surgery and Invasive procedures: Informed Consent Form (URDU)

Instruction for Informed Consent: An informed consent form is especially designed in Urdu to make is easy for the understanding of all patients. Informed consent is necessary for any invasive procedure, operation, surgery, admission, dialysis procedure (once only) & therapy. The cost of treatment is subject to the specific services availed by the patient and varies with the nature of the disease and treatment plan. However, a complete rate list is available at the front desk for patient’s reference. For package cases and surgeries, initial estimate is given on the “Informed Consent Form/Consultant’s Prescription” which may differ due to extended stay, unexpected outcomes, complexity of multiple diseases. Following instruction should be adhered to by the Doctors & Healthcare providers responsible for the health of the patients: The doctor or consultant is required to complete the informed consent over and above the general consent for treatment before carrying out any invasive procedure or operation. The informed consent by patient or their attendant is a mandatory prerequisite to carry out medical intervention. Refusal to signing the informed consent may lead to halt in the medical intervention and in such a case the consequences due to delay shall be the responsibility of the patient & their family. When the patient is unable to give their consent due to their state of consciousness or nature of his illness, it can be presumed as “Expression of Will” by the doctor to act in good faith. In life saving situations, patient or the attendants of the patient if are unable to complete Informed Consent in time, two doctors attending the case can act in good faith and sign the consent on behalf of the patient. In case the patient or the family of the patient refuses to sign the informed consent, the doctor may refer the case to arbitration or refer the patient to another hospital for second opinion/better care. The consent of the patient is required for preservation of a body sample for biopsy or histopathology to validate the correct course of diagnosis and treatment plan. The same can be used for clinical teaching and is regarded as patient’s acknowledgment to participate. The doctor, surgeon or consultant performing the treatment shall ensure that the patient or their attendants are informed about the diagnosis, proposed treatment plan, expected outcome, expected costs, risk factors, treatment options available to patients and follow up of patients are all explained and understood by the person signing the informed consent. Taking consent every time for procedures like dialysis is not required if the informed consent has been taken and documented in writing earlier. Patient’s diagnosis and medical record can be shared with the family to keep them on board of the treatment plan unless patient gives explicit instructions not to disclose the information for social reasons. For patients incapable of independent decision making, informed consent can be taken from spouse, son, daughter, brother, sister, parents or legal guardian. In case of unconscious or unaccompanied patients, two doctors can sign the consent in life saving circumstances. Name of the Person: ____________, Designation: ________, Date: __/__/20__ & Time: __:__ am/pm, Name of the Hospital’s Witness: ________ getting the consent form on behalf of the treating doctor.   Medical team On the unit we have seven ICU consultants who provide cover for the unit 24/7. Each consultant is on a rota to cover Monday–Friday and then do the following weekend. Although you may be introduced to different consultants they will be given an in-depth handover so they are aware of your relative or friend. The consultant is supported by a team of PG Trainees, Medical Officers,  Physiotherapists There is a  physiotherapy service for all patients on the ICU. A physiotherapists will assess each patient on a daily basis to identify any areas that may benefit from treatment. This may include: • Listening to the chest and clearing the lungs. • Maintaining a range of limb movements and mobility in bed, such as stretches and splinting. • Strengthening exercises and facilitating mobility such as transferring to a chair and aiding walking. It may come as a surprise to some people that while patients are so unwell they have physiotherapy—however it is at this time that it is so important for patients to be stimulated, as this plays a vital part in the recovery process. Not every patient will require the same amount of input—some patients will just have a daily review, whereas others may receive treatment three times a day. It is the role of the physiotherapist to determine how much input is appropriate for each patient. Sometimes it is useful to get relatives to encourage and help carry out exercises with the patient. Radiology & Ultrasound The radiographer takes images of the patient’s chest using an X-ray machine for ICU Patients. Most patients have a daily X-ray in the morning to check either the patient’s lungs or the placement of specialized lines.   While A Radiologist / Sonologist will perform a bed side Ultrasound ,Doppler studies for patient. Pharmacist In ICU patients receive a lot of drugs. The role of the pharmacist is to ensure patients are given appropriate medicines, the unit has an adequate supply, and to answer any questions staff have relating to medications. Speech & Language Therapist The role of the Speech & Language Therapist in intensive care is to assess and treat eating and swallowing problems that critically ill patients may have. Infection control Infection control is extremely important in ICU and there are a number of ways you can help us in this area. Please ensure you clean your hands on entering and leaving the unit by either washing your hands or using the alcohol hand gel placed around the unit. Please do not handle any lines or Tubing Refrain from sitting on patients’ beds Do not bring flowers/plants into the unit Keep patients’ property to a minimum Do not bring young babies/children into the ICU however, in exceptional circumstances, please discuss this with the nurse in charge. Please speak to a staff member if you have any queries about infection control issues. Making Enquiries We ask that the family or friends of the patient nominate one person who can inquire from the ICU and pass the information on. This will save us repeating the same information to many different people. At times it may be necessary to restrict the information that we give on the phone to maintain patient confidentiality. If you would like to talk to the doctor you only have to ask a member of staff and this can be arranged. It is our Endeavour to inform the patient’s family on the prognosis of the patient at every stage. If things remain unclear on the patient treatment pathways the Hospital formulates a Medical board to give a holistic view to the patient and discuss treatment options with family members. If a patient dies The purpose of an Intensive Care Unit is to treat seriously ill patients and hopefully help them recover. In some cases, however, despite all our best efforts a patient will not regain consciousness. In these situations the doctors may need to discuss the appropriateness of further treatment. Doctors are usually able to warn those concerned if their relative is approaching a critical stage. But sometimes a patient will die suddenly, for example from a heart attack or stroke. If that happens we will try to answer any questions you may have. After a death The death of someone close to you can leave feelings of anger, numbness, tiredness and helplessness as well as deep sadness. Coming to terms with your loss can be a long process and it is perfectly natural for it to take time. Immediately after death of a patient the hospital staff shifts the Cadaver to the Mortuary located in the Rear Car Parking of the Hospital. This is done to maintain the dignity of the deceased and to comfort the bereaved family on their loss.  After Formalities are completed and bereaved family is ready to receive the body for making burial and Funeral arrangements the Cadaver is handed over.