Our Patients

Any patient, regardless of age and co-morbidities, who suffers a severe but potentially reversible illness may be considered for admission to the Intensive Care Unit. The conditions we treat include:

• Multiple organ failure and shock secondary to a variety of causes including septic shock, severe pancreatitis, cardio-respiratory arrest, massive blood loss/transfusion
• Cardiovascular failure/cardiogenic shock requiring invasive haemodynamic monitoring and inotropic support or intra-aortic balloon counter-pulsation
• Severe infections resulting in organ impairment/failure
• Postoperative patients following emergency or elective major surgery
• Metabolic disorders requiring close monitoring such as diabetic ketoacidosis, symptomatic hyponatraemia, particularly if there are significant other co-morbidities
• Respiratory failure requiring close monitoring or ventilatory support (invasive or non-invasive)
• Poisonings (inadvertent or self-inflicted) with significant organ impairment or risk of serious complications
• Acute renal failure requiring renal replacement therapy
• Multiple trauma involving significant chest/abdominal/pelvic injury or massive blood loss but not involving neurotrauma
• Pregnancy-associated complications with organ impairment/failure

ICU Staff Responsibilities

Our primary responsibility is to care for the patients within the Intensive Care Unit, and for their families. We assist with the care of critically ill patients throughout the hospital by participation in the Code Blue (Cardiac Arrest) Team, which also effectively functions as a medical emergency team, and by attending urgent referrals. Ward patients with complex care needs and patients recently discharged from ICU receive the assistance and support of our ICU Liaison Nurses. The ICU staff also coordinate the in-patient Parenteral Nutrition Service.

Research Activities

We have a strong interest in clinical research as a means of providing evidence based guidance for the care of the critically ill and participate in a number of multi-centre studies. We are involved with the ANZICS (Australian and New Zealand Intensive Care Society) Clinical Trials Group and participate in multicentre studies under its auspices and also participate in various commercially sponsored pharmaceutical trials. These activities are supported by two ICU research nurses.

Audit and Quality Activities

Quality patient care is our highest priority and our audit team, led by one of our senior staff specialists Dr Ann Whitfield, undertake a number of activities to ensure that our care remains excellent. We collect and submit de-identified information on all admissions to the ANZICS Adult Patient Database which analyses the data and produces reports on topics including acuity of illness, risk adjusted mortality, age and patient flow through the Unit. This information is benchmarked against the national data-set of all ICUs contributing to the Adult Patient Database. In addition, our audit team provides regular monthly reports to the ICU leaders to assist in monitoring service delivery and achievement of key performance indicators. We also perform clinical and organisational audits on a regular or as required basis, depending on the variable being assessed.

Courses

We have a great commitment to the education of junior doctors and doctors training in the speciality of intensive care medicine. One of our senior staff specialists, A/Prof Ramesh Nagappan, convenes the  Acute Care Medicine Course each year at Box Hill Hospital, a popular course that attracts doctors from throughout Australasia. He also runs an acute care medicine course for junior doctors at Box Hill Hospital with fortnightly lectures. The ICU Director, A/Prof David Ernest, and A/Prof Ramesh Nagappan are co-convenors of the annual ANZICS Intensive Care Medicine Course which is directed at doctors intending to specialise in Intensive Care Medicine. All of our staff specialists contribute to these courses, which are further supported by our secretarial, clerical and nursing staff.

Information for Relatives and Patients

The ICU Environment

Visiting

The ICU Environment

Our ICU is a large purpose-built area with specialised equipment and monitors. to enable us to care for our critically ill patients, we have a higher ratio of doctors and nurses to patients than found in other areas of the hospital. Every patient in ICU has a monitor (a television-like screen) that can monitor the patient's heart rate and rhythm, blood pressure, temperature, breathing and many other things. Most patients will have powerful drugs given to them continuously through intravenous infusion pumps (‘IV’ or ‘drip’). Patients may also be assisted in their breathing by a machine (ventilator). They are attached to the machine by a tube inserted into the trachea (windpipe) or by a tight fitting face or nose mask. A variety of other complex machines may be used to assist failing organs and provide life support.

Intensive Care Units (ICUs) are intimidating places to visit. With the knowledge that your loved one is seriously ill, coming into an ICU may be overwhelming for you. Strange sights, smells and sounds may confront you when you enter this new place and it may be difficult to make sense of this information. When you first visit, the ICU staff will explain the routines in the ICU, the visiting hours and restrictions and what to expect when you see your loved one. Members of our staff are here to help you and are committed to providing the best possible care to both your loved one and you. Please do not hesitate to ask the staff if you have questions about the hospital routine, your loved one's illness, or other matters.

Visiting in our Intensive Care Unit

We have some restrictions on visiting. These are to protect patient privacy, to avoid over-tiring our patients and to allow staff to continue the high intensity care required. The restrictions we request are:

• We ask that visitors be limited to the immediate family and that only two visitors be present at the bed-side at any one time. This is due to the limited space at the bedside and to avoid tiring the patient. Close friends and extended family members may visit with the permission of the family or patient.
• We also ask that visitors not be present during the morning and evening ward round to protect the privacy of patients in adjacent bed areas. The ward rounds are performed by a team made up of the ICU consultant, junior doctors and nurse-in-charge and the management of each patient is extensively discussed. Each ward round takes 1-4 hours depending on the number of patients and the complexity of their illnesses.
• Visitors are asked to come to the ICU reception before entering the unit. The receptionist will then check if it is alright for you to visit. You may be asked to wait if essential procedures or investigations are being performed.
• If a visitor is coming to see the patient in the middle of the night we ask that we be told of this so that we can notify hospital security to allow the visitor to enter the hospital.
• Children are allowed to visit although we suggest that this be discussed first with a senior member of the medical or nursing staff or the social worker as your child may be distressed by the condition of the patient.
• You will be requested to use a hand-cleanser on entering and leaving the unit. Intensive care patients are very vulnerable to infections. The staff of the ICU routinely washes their hands between patients to reduce the transmission of infections. It is important that visitors wash their hands to reduce the transfer of infections as well.

With the above restrictions, visiting is possible at any time 24 hours a day 7 days a week.

Getting Information

• It is important that the family select a spokesperson or "First Contact" person, if this has not already been done by the patient. This spokesperson should be the main person to ring to request information and will be the person the hospital team contacts if there are unexpected changes in the patient's condition. We ask that the spokesperson pass on information to the rest of the family.
• When you visit, you can ask the bedside nurse to update you regarding the patient's progress. You may also ask to speak to one of the doctors - this will usually be possible but there may a delay.
• Family meetings may be organised to enable one of the ICU doctors to update the family as a group. These meetings may be arranged by the ICU staff if there is important information to be passed on to the family regarding the patient's condition. They may also be requested by the family if they are feeling confused and uncertain as to what is happening.

Contacting the Intensive Care Unit

Immediate family members are given a business card with direct contact numbers for the Intensive Care Unit. The Unit may also be contacted via the hospital switchboard on + 61 3 9895 3333. In general the condition of patients in the Intensive Care Unit prevents them from using a phone so bedside phones are not available.

Information for Staff

Nursing Staff

Registrars and Trainees

Nursing Ratios and Support

Registrar Positions

Education

Courses

Wages and Conditions

Recruitment

Nursing Staff

Box Hill Hospital ICU employs approximately 100 registered nurses on 8, 10 and 12 hour shift patterns.  We offer flexible, request driven rostering, as well as a solid ‘in-house’ educational program facilitated by a full-time ICU clinical nurse educator.

Nursing Ratios and Support

We function on the basis of one Registered Nurse (RN) per ICU patient, and one RN per two high dependency patients. Each shift is supported by both a supernumerary Shift Co-ordinator and a Clinical Resource Nurse who are senior experienced Critical Care Nurses. An ICU Equipment Nurse is present during the week to provide education and support with equipment.

Education

Nursing education in the Intensive Care Unit is supported by a Clinical Nurse Educator and Clinical Resource Nurses who provide clinical education and support including:

• A comprehensive education program for all staff

  • this program is collaborative with the ICU medical staff. We also share education sessions in a forum format with ED and CCU staff on a regular basis.

• Clinical Development Program incorporating the Introduction to Critical Care Program

  • This structured program provides nursing staff with a supported opportunity to develop skills in critical care nursing and to become effective contributors to the critical care team. The program runs twice yearly over six months and includes 52 hours of theory and guided practicum, provided by Box Hill Hospital critical care educators and invited experts from nursing, medicine and allied health with resource materials provided. It has been operating very successfully for several years and offers a guided experience based on adult-learning principles in a workbook-supported framework that is able to equip nurses for meaningful practice and, should they choose, further postgraduate studies in critical care. Candidates may apply for advanced standing in postgraduate studies in critical care at Deakin University on successful completion of the program assessment criteria and an optional academic component.

• Postgraduate Studies

  • Box Hill Hospital is affiliated with Deakin University. In conjunction with the University we offer a Postgraduate Diploma and Postgraduate Certificate in Nursing Practice, across all critical care disciplines, including Critical Care and Intensive Care. Students enrolled in the Critical Care program rotate through the ICU, Emergency department (ED) and Coronary Care Unit (CCU), while those enrolled in the Intensive Care program specialize and consolidate their practice with the majority of their experience gained in the ICU.

Nursing staff interested in more information or in applying for these courses should contact the ICU Clinical Nurse Educator, Dr Paula Eustace on:

• Ph: + 61 3 9895 3149
• email: mailto:paula.eustace@boxhill.org.au

Wages and Conditions

Wages are paid according to the Registered Nurses award of Victoria. Further detail can be found at the Australian Nursing Federation. Box Hill Hospital offers salary packaging to optimise net income - this allows staff to package a percentage of their income tax-free towards loans, household bills and other appropriate expenditure. Full time staff accrue one day off per month and accumulate 6 weeks paid annual leave. Payment is fortnightly, direct to your account.
Recruitment
For any enquires please contact the ICU Nurse Unit Manager, Marisa Andreazza on:
Ph: + 61 3 9895 3149
email: marisa.andreazza@boxhill.org.au

Registrars and Trainees

We have a two tier system of ICU Registrars providing 24 hour cover for the Unit with two registrars on at any time.

The senior registrar positions include 3-, 6- and 12-month rotations in ICU and are suitable for both registrars enrolled in the Joint Faculty of Intensive Care Medicine training program or registrars in other specialty training programs who wish to gain further postgraduate experience in Intensive Care medicine. Our Unit is accredited by the Joint Faculty of Intensive Care Medicine for one core year of training and we are able to provide excellent experience in the care of a wide variety of critically ill patients given our high proportion of emergency admissions. Suitable trainees will also be able to undertake their Senior Registrar training component within our ICU. Our ICU consultants are closely involved in the day-to-day running of the unit and provide a level of supervision that is appropriate to each registrar's experience. We have a strong commitment to registrar education and provide regular education sessions and opportunities for hands-on training. We are able to arrange rotations in anaesthesia, emergency medicine and other specialty areas for suitable candidates.

The junior registrar positions are filled by registrars from the Emergency, Surgical, Critical Care and Physician training streams in Eastern Health. Their rotations are on average three months long. The Critical Care Training year includes rotations in the Emergency Department, Anaesthetics and ICU. It is suitable for junior registrars who have commenced their basic training in one of these specialties or registrars who are interested in further experience in these areas.

Registrars interested in applying for these positions should contact the Director of ICU, A/ Prof David Ernest:
Ph + 61 3 9895 3149
Email: david.ernest@easternhealth.org.au