Department of Critical Care
Gloucestershire Royal Hospital
Visitors Information Guide
Contents
About the Department of Critical Care ............................................... 4
Critical Care Team .............................................................................. 5
Contacting DCC and visiting information............................................. 6
Arrival at DCC/Patient property ......................................................... 7
Equipment ......................................................................................... 8
Bedside monitor ................................................................................ 9
Breathing machines ......................................................................... 10
Artificial kidney machine .................................................................. 12
Lines and infusions ........................................................................... 13
Pain relief ......................................................................................... 14
Nutrition .......................................................................................... 15
Sedation and delirium ...................................................................... 16
Infection control .............................................................................. 17
Facilities ........................................................................................... 18
Going to the ward from DCC/Further information ........................... 19
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This guide has been produced to familiarise you with the
department of critical care and have a better understanding
of aspects of critical care.
We appreciate this can be a worrying and stressful time for
you. Reading through this guide may answer some of the
questions you have.
The doctors and nurses at the bed side are available to
discuss any questions you may have regarding patient care
and are here to support you through this difficult time.
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About the Department of Critical Care
The Department of Critical Care (DCC) is a special ward that provides care for
people who are critically ill, have an unstable condition or may require close
monitoring after surgery. Patients can be admitted from all speciality areas in
the hospital.
DCC provides care in a combined intensive care unit (ICU) and high
dependency unit (HDU).
High dependency care is for patients requiring more care and monitoring than
can be given on general wards. One nurse is usually allocated to two patients.
Intensive care patients require constant medical support to keep their body
functioning. They may not be able to breathe on their own and they may have
multiple organ failure. Medical equipment takes the place of these functions
while the person recovers.
As a patient’s condition changes it may be necessary to move to different areas
within DCC.
Occasionally it may be necessary to move a patient to another hospital or
another part of the hospital for specialist care.
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Critical Care Team
Whilst in DCC, patients will be seen regularly by their own hospital consultant.
Their care will also be supervised by a DCC specialist consultant. They will see
patients several times each day as necessary, and are continually available to
direct treatment and keep family informed of progress. These specialist
consultants supervise the DCC for up to a week at a time, changing at the
weekend; they are supported by a team of assistant doctors.
Nurses are usually allocated to look after one or two patients at a time and
provide much of the daily care. Most of the nurses have received specialist
training in Critical Care and are skilled in all aspects of patient treatment. They
will also make sure you fully understand the treatment being given and answer
any questions you may have. Handover between nursing staff happens at the
end of each shift and all aspects of care are passed on to the nurses taking
over.
Ward Staff
Some of the uniforms you may see in DCC are:
Modern Matron: - Navy dress/ tunic/trousers, burgundy piping
Sister: - Navy blue dress / tunic / trousers.
Charge nurse: - Navy blue top / trousers
Staff Nurse: - Blue and white striped dress / tunic and navy trousers.
Male Staff Nurse: - Navy trousers, white tunic with blue epaulets.
Student Nurse: - Pale Blue top/dress.
Nursing Auxiliaries / Health Care Assistants: - Green / white striped uniform.
Many other staff help to look after patients whilst in hospital, including
specialist nurses, physiotherapists, pharmacists, radiologists and housekeeping
staff.
When a patient is so unwell their condition may change quickly. Therefore the
information you receive may sound different on a daily basis. Please ask the
nurses or doctors if you are confused or need any further information. The
doctors and nursing staff will try to update you regularly on any changes
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Contacting DCC and Visiting Information
Main Hospital Switchboard 08454 222222
Gloucester DCC direct Number 08454 226178
It is helpful if enquiries are made by one or two nominated contacts who can
pass on information to others.
You can telephone to ask about your relative at any time, even overnight. We
would rather you phone and enquire than sit at home worrying. In order to
maintain patient confidentiality, it may be necessary to restrict the information
we give on the telephone.
Mobile phones should be turned off or on silent mode and not used around
patient areas. Phones can be used in reception or outside DCC.
Visiting
We don’t have strict visiting times but usually recommend visiting in the
afternoon. Mornings are usually busier and you may have to wait for long
periods. This can be negotiated with the nurses in DCC.
When a patient is critically ill you will be advised that you may visit at any time.
We do not limit the amount of time you visit but we do recommend, that you
and the person you are visiting are given adequate time to rest.
We advise that only relatives and close friends visit patients in DCC. This
ensures patients receive the rest and quiet which is an important part of their
recuperation and enables staff to complete their duties.
We may have to ask visitors to leave the unit for procedures or examinations.
You may have to wait for some time so please be patient and bear with us. If
you feel you have been waiting for at least 30 minutes or longer than expected
ask the receptionist or phone through to the unit using the phone on the
reception desk.
For the safety and comfort of our patients we ask for no more than two visitors
at the bedside at any one time.
Older children may be able to visit critical care areas but can find it distressing.
If you intend to bring children, you will need to speak to the nurse in charge
who may need to prepare carefully for their visit.
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Arrival at DCC
The main doors are locked at weekends and outside office hours. Please use
the entry phone located at the side of the main door to speak to staff on the
unit.
During office hours the receptionist will let nursing staff know you have
arrived. Otherwise use the phone on the main desk to speak to the nursing
staff and make them aware you wish to come into the unit. You may have to
wait a short time if nursing staff are very busy, please be patient.
Please do not enter the unit without permission. This is to promote patient
privacy and may prevent you walking into an emergency situation or
procedure.
Your relative or friend can often look very different with lines and machines
attached and their face and arms may appear puffy. It is normal to feel upset
and worried when first visiting someone in DCC. While looking after patients,
the nurses and doctors are also there to help you understand and explain what
is happening.
Patient property
Due to limited storage space large amounts of property may need to be
returned home. We recommend leaving valuables or money at home. It may
be necessary to ask family members to take property home or lock it away in a
secure area to be returned later when the patient is well or transferred to
another area.
Personal belongings and property a patient may need includes:
 Soap or shower gel
 Brush or comb
 Toothbrush and toothpaste, dentures if usually worn
 Shaving equipment
 Slippers and nightdress or pyjamas when recovering and starting to get
out of bed
 Glasses
 Books or magazines
Any electrical equipment will need to be sent to medical physics to be safety
checked before it can be plugged into electric sockets around the bed space.
We ask that no flowers or plants are brought in for infection control reasons
and to prevent accidental spillage. Some cards and photographs may be put in
the bed space.
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Equipment
There is a lot of equipment in a critical care area and it may be helpful to
understand what the various pieces of equipment are for and what some of
the readings they display mean.
All patients have monitoring leads and equipment attached to them when
they arrive on the unit. This allows the staff to closely monitor their condition
and guide treatment.
When a patient is initially admitted to the unit it can take an hour or two,
sometimes longer to settle them in. This is normal and allows the staff to
stabilise the patient and perform tests.
The following pages list a few of the more common pieces of equipment found
in DCC.
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Bedside Monitor
When patients are admitted
to DCC they will be attached
to a bedside monitor. The
monitor gives continuous
readings of heart rate (ECG),
blood pressure, oxygen levels,
and breathing rate. These
numbers change frequently
and audible alarms are set to
alert staff to changes and
should not worry you.
Small sticky pads are placed on the chest and attached to leads. The patient’s
heart produces electrical impulses that are picked up and show on the bedside
monitor allowing us to measure heart rate and detect abnormalities.
Oxygen saturation measures the amount of
oxygen carried in blood. This is usually
measured from the patient’s finger or ear.
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Breathing Machines
A ventilator is a machine used to
support breathing. Air and oxygen is
blown into the lungs from the
ventilator and can take over
breathing for the patient or be used
to support breathing.
The ventilator will be attached to a
tube going through the mouth and
into the lungs (endotracheal tube or
ETT). This tube can be
uncomfortable and sedation will be
required to tolerate treatment.
Some patients are able to wean quickly from ventilation and have the ETT
removed. Other patients will need a tracheostomy to wean them from
ventilator support.
A small tube is inserted through the neck into the trachea. This allows sedation
to be reduced or stopped and the patient to wake up. Weaning from the
ventilator can be planned as the
patient’s condition allows. A patient
will not be able to talk with the
tracheostomy tube but can usually be
understood by lip reading or writing.
The patient’s voice should return
when the tracheostomy tube is ready
to be removed. They may be able to
take diet and fluids with assistance.
The endotracheal or tracheostomy
tubes allow removal of secretions
from the patient’s chest by suctioning.
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Most critical care patients need extra oxygen. This may be delivered by an
oxygen mask or a tube up the nose.
They may need extra support from non
invasive ventilation also known as CPAP
or BiPAP. This means using a special
tight fitting mask which helps them when they are having
difficulties with breathing. The mask makes it difficult for
the patient to talk and may be uncomfortable. Short
breaks can be taken off the mask with a nurse present for
mouth care and drinks if possible.
High frequency oscillatory ventilation is a special form of
ventilator used when a patient cannot be treated
effectively using conventional mechanical ventilation.
Small and fast breaths are delivered to the patient and
they may need to be well sedated to receive treatment.
This machine can be noisy.
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Artificial Kidney Machine (Filter)
An artificial kidney machine or filter replaces
the function of the kidneys when they are not
working properly. It is used to remove waste
from the blood and manage fluid levels. Blood
circulates from the body through the machine
where it is filtered and then returned. This
works in a similar way to dialysis but a more
gentle process (haemofiltration or CVVH).
A special large tube (vascular cannula or
vascath) is inserted into a vein usually in the
leg or neck to do this.
A urinary catheter may be inserted to measure
urine output and allow staff to monitor kidney
function.
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Lines and infusions
You will see a variety of tubes and lines attached to each patient, used for
blood sampling, feeding, giving drugs and fluids and removal of waste.
Some of the lines and tubes needed include:
Arterial line
An arterial line is a thin catheter inserted into an artery to monitor the blood
pressure continuously, to obtain blood samples for lab analysis, and for arterial
blood gases (ABG) analysis. It is often inserted in the wrist or groin. ABGs allow
us to determine the pH of the blood and measure oxygen and carbon dioxide
levels.
Central venous catheter (CVC)
A line placed into a large vein in the neck , chest or groin. It is used to
administer medication or fluids, obtain blood tests and directly obtain pressure
measurements in the vein - central venous pressure (CVP).
Peripheral Venous Cannula
Small lines usually inserted in the hands or arms and sometimes legs or feet to
administer drugs or fluids.
Infusion Pumps
A medical device that infuses fluid, nutrients, and
drugs into a patient’s body in controlled amounts.
It is generally used intravenously.
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Pain Relief
Epidural
Following some types of surgery or injuries an epidural
can be used to provide pain relief and numb sensation. A
fine plastic tube (epidural catheter) is inserted into the
epidural space in the back. An epidural pump allows local
anaesthetic to be given continuously and blocking nerves.
This can cause a feeling of numbness that returns when
the epidural infusion is stopped.
Patient Controlled Analgesia
Allows to patient to administer their own
pain relief. A pump containing pain killers
allows the patient to administer a set
amount of the prescribed drug
intravenously.
To prevent them from being in pain or uncomfortable, almost all patients in
DCC will receive pain relief in various forms. They are frequently given as
tablets, liquid or as injections.
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Nutrition
Providing adequate nutrition is very
important to help with healing and
recovery from illness.
When someone is not able to eat and
drink they may need a nasogastric tube
inserting for feed. This goes through the
nose and into the stomach and can be
easily inserted on the unit. Position of
the tube can be checked by x-ray or
aspirating acid from the stomach.
A feeding pump is used to deliver a
controlled amount of liquid nutrition
into a patient via the nasogastric tube.
Medication can also be administered
through the nasogastric tube.
For some patients requiring longer term nutritional support, it is also possible
to insert a tube for feeding through the abdominal wall into the stomach or
gut, gastrostomy tube or jejunostomy tube.
Patients will be encouraged to eat and drink when they are able to do so. A
menu will be provided to choose meals from the kitchen.
Most patients will be referred to the dietician for advice and supplements to
their diet. You can bring in small amounts of food and drink from home that
does not need to be heated.
If feeding is not possible IV fluids or liquid feed may be used as a replacement.
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Sedation
Use of sedation and pain relief is important for the comfort and safety of
patients. Sedative drugs are usually given along with drugs for pain relief.
Patients can be heavily sedated and unresponsive or are more often lightly
sedated and often partially awake. The nurses and doctors will keep reassuring
the patient and make sure that they have plenty of pain relief to minimise any
uncomfortable procedures that need to be done.
Relatives often want to know if they can talk to the patient or touch them and
this is usually encouraged. It can often be reassuring and calming to hear a
familiar voice. They may be able to hear what is being said even if they are not
responding. Please ask a nurse if you are worried about touching lines or wires
attached to hands and arms or in the bed.
If patients are going to be in DCC for a long time it can be useful for family or
visitors to be involved in a patient diary. This can be used later on in recovery
to fill in gaps in memory caused by sedation or medication.
Delirium
Critical care patients can often suffer from a condition known as delirium.
Delirium is confusion that comes on quickly. The patient has trouble thinking
clearly, is unable to pay attention, and may not know where they are or what is
happening around them.
Delirium can have many causes including:
Medication and drugs
Critical illness
Severe pain
Infection and medical illnesses
Prolonged lack of sleep
Previous alcohol and drug abuse
I f you are concerned that your relative or friend is confused, low in mood or
displaying unusual behaviour it would be useful to let nursing or medical staff
know so they can observe and treat if necessary.
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Infection Control
Hand washing. This is to help keep DCC clean and prevent the spread of
infection to other areas. This protects you and the DCC patients. The most
common means by which infection is transmitted is by hand, therefore hand
washing is a very basic, yet vital infection control measure.
Stringent infection control procedures are applied to all staff and visitors.
Please do not be afraid to ask staff to wash their hands.
Alcohol hand gel is kept at the entrance of the ward and at each bedside for all
the visitors to use before and after visiting. For hygienic hand disinfection
apply to physically clean hands for 30 seconds ensuring all areas are covered,
rub until dry. Please inform a staff member if the alcohol gel requires
replacement.
We ask that visitors suffering from diarrhoea or vomiting or minor infections
such as a cold avoid visiting if possible, for their sake as well as the patients.
We do not recommend babies or young children being brought in to visit, again
for their own protection.
Visitors are requested not to sit on patients beds and use chairs provided, this
is to help minimise the risk of spread of infection and for other health and
safety reasons.
Some patients need to be isolated because they may have an infection or be at
increased risk of developing an infection. The nurse or doctor responsible for
their care can answer questions about this, and advise you on washing your
hands, or wearing aprons or masks if necessary to prevent spreading infection.
On admission to the department, all patients are routinely checked for
Methicillin Resistant Staphylococcus Aureus (MRSA). A leaflet explaining more
about this can be found in the waiting area.
Please do not hesitate to contact the matron or nurse in charge if you have any
concerns about care or cleanliness.
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Facilities
Parking can be found in the multi-storey car park near the tower entrance and
various car parks around the site.
A concessionary weekly parking permit may be available if the patient has
been an inpatient for 14 days or more.
The patient is critically ill and needing the ongoing support of Critical Care
services, for longer than 3 days, but excludes patients who subsequently well
enough to return to a ward, but awaiting a bed
After 3 days if the Patient is diagnosed as terminally ill
A form is available from the nurses in DCC.
Further information and costs can be found in the leaflet rack in the waiting
room or from the parking office.
There is a waiting room with drinks facilities for visitors within DCC and a toilet
in reception.
Food and drinks are available from Fosters restaurant, WRVS shops and
vending machines. Please do not consume food or drinks in the clinical area.
There is a small bedroom which can be used for 1 or 2 nights stay if you travel
a long distance or your relative is particularly unwell. Please ask the nurse
looking after your relative.
It is important to look after yourself and take regular breaks when visiting.
Cash point can be found
Chaplaincy staff visit the wards or you may arrange for your spiritual advisor to
visit.
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Going to the ward from DCC
Transferring to the hospital ward means patients no longer need the specialist
treatment provided in DCC. It is an important and positive step on the way to
recovery.
For the first few days on the ward patients may be visited by specialist nurses
that work with the DCC team. Acute care response team will monitor progress
and provide any further advice needed to help recovery continue.
Further Information
Many information leaflets can be found in the leaflet rack in the waiting area.
Please ask the receptionist or nurses if they are not available or you require
help finding further information.
PALS Patient Advice and Liaison Services
Useful websites:
Winston’s wish www.winstonswish.org.uk
GRH ICU charity website
Intensive Care Society www.ics.ac.uk
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A visitors guide to Critical Care at Gloucestershire Royal Hospital