CICM Policy Documents - Summaries
IC-1 – Minimum Standards of ICU’s
Type of unit – Level I, II or III, HDU, PICU
Case load
Staffing (medical, nursing, allied and other with clinical and non-clinical duties)
Training – C6, C12 or C24
Operational requirements – site and design (20m2 bedspace)
Equipment – basic and advanced with in-service training
Monitoring – staff, patient and transport
IC-2 – Intensive Care Specialist Practice in Hospitals Accredited for Training in
Intensive Care Medicine
Clinical
Non-clinical
Clinical supervision guidelines
Trainee Supervision guidelines
IC-3 – Guidelines for Intensive Care Units seeking accreditation for Training in
Intensive Care Medicine.
General
Levels – I, II, or III
Classification – C6, C12, C24
Safe staffing
Education – teaching and research, M+M
College assessments
SOT
Support staff
IC-4 – Supervision of Vocational Trainee’s in Intensive Care Medicine
By a FCICM
For:
- major procedures
- quality assurance
- sensitive communications with patients and families
- record-keeping
- research
- audit
- training
Jeremy Fernando (2011)

Categories:
C1 – present and helping
C2 – available for immediate assistance and consultation
C3 – present in hospital
C4 – out of hospital but available
Special situations:
- admission
- unplanned discharge
- important changes in condition of patient
- complex procedures
- treatment of children
- serious ethical changes to management (withdrawal, organ donation)
- refusal to admit
- retrieval or re-patriation
IC-5 – Guidelines on the Health of Specialists and Trainees
General – at risk group, health checks, vaccinations, screening for disease, stress management
Personal – GP, no self prescription, no corridor consultations
Professional – promote health attitudes, resource availability, discussion of health related topics, mentor and buddy systems, review of rostering and work practices, fatigue avoidance, debriefing and support.
IC-6 – Guidelines for the Relationship between Fellows, Trainees and the
Healthcare Industry
- open and formal acknowledgement of financial healthcare industry support
- disclaimers
- goal should be patient benefit
- personal negotiation doesn’t imply College approval
- organised by College and sponsored by Health Care Industry
- organised by Healthcare Industry
- mediation
- normal ethical committee procedures must be followed
Jeremy Fernando (2011)

IC-7 – Administrative Services to Intensive Care Units
Individual secretarial
Administrative
Educational
Research
IC-8 – Quality Improvement
Definition = interdisciplinary process designed to raise standards of preventative, diagnostic, therapeutic and rehabilitative measures to improve outcomes.
Measurement
Improvement Process – planning, implementation, evaluation, ensure sustainability
Programs
- assessment of structure
- process
- internal events: M+M, delays in transfer, complicance with protocols, critical incident reporting, risk management
- external comparisons: APACHE II -> SMR, CRBSI rates, patient/relative satisfaction
Audit
Quality improvement co-ordinator
IC-9 – Ethical Practice in ICM
Ethical and Legal responsibilities
- autonomy
- beneficence
- non-maleficence
- social justice
- fidelity (confidentiality, truthfulness, education, vigilance, devotion)
- paternalism
- utility (best use of resources)
- informed consent
- patients and staff rights
- patients and staff responsibilities
- clinical research and teaching
- professional conduct
- familarisation with relevant statutory requirements in practising country
IC-10 – Minimum Standards of Transport for Critically Ill Patients
- high risk time for patient
- standard of the care should not drop during transport
Jeremy Fernando (2011)

- risk of transport must we weighed up by benefit of investigation or intervention after transport.
Administration – initiation, coordination, responsibility, documentation, audit and quality assurance
Categories – prehospital, interhospital, intrahospital
Staffing – senior, adequately trained, adequate communication, consider taking specialist skill to referring hospital
Transport – mode, vehicle, urgency
Equipment – A, B, C, drugs and other
Monitoring – A, B, C, D
Training
IC-13 – Recommendation for Standards for HDU’s
HCU = intermediate day between ICU and ward
- near ICU
- referred to ICU
- defined admission, discharge, management and referral policies
- ICU oversight
- nursing ratio 1:2
- 24 hour cover
- minimum of 4 beds
- 16m2 bed space
- A, B, C, D, E and drugs
IC-14 – Statement on Witholding and Withdrawing Treatment
- appropriate in some circumstances
- benefit vs burden
- no obligation to initiate or continue ineffective treatment
- take into account: advanced directives, next-of-kin, primary medical practitioner or another patient confidante.
- we must assess competence
- allow time
Jeremy Fernando (2011)

- we need to take responsibility for decision (not place burden on family)
- document well
- never withdraw care -> we move to a comfort care model
- cause of death is the medical condition that necessitates the treatment that is withheld or withdrawn
Jeremy Fernando (2011)