The ICU Medical and Nursing team are supported by a range of Allied Health professionals, who work within the ICU to provide the best possible holistic care for our patients. These include Pharmacists, Physiotherapists, and Nutritionists.
Physiotherapy is considered a vital part of a patient’s recovery following serious illness and as such, Frankston ICU is staffed by a team of highly trained therapists, led by Tess Baker, 7 days per week. Two senior physiotherapists work in the unit on weekdays, providing training and support to our junior staff, which rotate on a 4 monthly basis.
Our primary role is to assist in optimising the function of a patient’s cardiorespiratory and musculoskeletal systems through both exercise and specialised physiotherapy techniques. There is a growing body of evidence to support early rehabilitation for patients requiring intensive care, even those who are still very sick and mechanically ventilated. This has been safely shown to reduce physical deterioration, improve mood and aid in the recovery of various respiratory conditions. To fulfil our role, physiotherapists have extensive knowledge on body systems and exercise physiology, as well expert manual handling skills to assist moving more debilitated and complex patients. Physios also utilise a number of techniques to assist airway clearance and optimise respiratory function. We are able to apply non-invasive ventilation (NIV) and manipulate mechanical ventilator settings to clear airway secretions or re-expand areas of collapsed lung. In conjunction with the medical team and speech therapist, physios play an important role in weaning from mechanical ventilation and we also help facilitate the process of removing a patient’s tracheostomy tube.
We ensure that our practice is both safe and evidence based. As a result, the importance of mobilising even the sickest of our patients to maintain or improve strength and mobility is considered a high priority.
The clinical pharmacy services are provided by a team of experienced clinical pharmacists for about 4 hours daily on Mondays to Fridays. This team is led by Alice Lam. Clinical Pharmacists ensure the safe and optimal use of medicines in ICU through:
- Attending ward rounds;
- Obtaining and verifying a complete and accurate list of each patient’s current medicines;
- Matching the medicines the patient should be prescribed to those they are actually prescribed (any discrepancies are discussed with the prescriber to ensure patients receive all intended medicines);
- Reviewing drug therapies to prevent incidences of adverse drug effects;
- Advising nursing and doctors on drug administrations, drug dose adjustments, drug compatibilities, formulation options, enteral drug administration;
- Assisting in appropriate drug choices especially antimicrobial therapies;
- Supplying the right medicines in a timely and cost efficient manner;
- Ensuring legal compliance, such as obtaining and supplying information for accessing unlicensed medicines through the Special Access Scheme for any ICU patients who may require any unusual drugs and obtaining prescribing permit and warrants;
- Liaising with the dietician and are involved in the decision making to initiate total parenteral nutrition (TPN), monitoring of electrolytes; and
- Reviewing ICU policies and clinical practice guidelines.
Pharmacy has also contributed extensively in the implementation and training of the Peninsula Health’s electronic medication management system CLOVeR (CLinical Ordering, results Viewing, and E-pRescribing). Peninsula Health is one of the leading hospitals in Australia using this powerful tool in ICU to enhance medication safety. Patient’s medication information can now be viewed and accessed, using mobile devices, e.g. iPad™ and desktop computers.
Pharmacy has worked collaboratively with the ICU clinicians to develop the Smart Infusion Pump Guardrails™ drug libraries to ensure safe intravenous administration of potent drugs. Together we regularly review and update drug infusion guidelines to ensure the safe and effective use of medications.
Evidence has also demonstrated that the contribution of ICU clinical pharmacist has reduced mortality and morbidity, improve medication safety and effectively manage drug costs.
ICU dietician Fiona Turnbull attends the ICU ward rounds to optimise the nutrition of all critically ill patients admitted to the intensive care unit.
The Intensive Care Unit at Frankston hospital has participated in a number of multicentre nutrition trials including the Early PN trial, International nutrition surveys and the ENTERIC trial, which have guided clinical practices.
The Early Parenteral Nutrition in Critically Ill patients with short term contraindications to Early enteral nutrition – A randomised Controlled trial looked at commencing parenteral nutrition within 24 hours of ICU admission if patients were expected not to receive nutrition on that day or the following day. Early parenteral nutrition did not lead to significantly reduced 60 day mortality, however it was associated with significantly fewer days of mechanical ventilation, significantly less muscle wasting and fat loss and a full economic analysis demonstrated that it would reduce total costs of acute hospital care by US$3,150 per person.
The international nutrition surveys aim to compare current nutrition practices in ICUs within and across different countries and are an ongoing quality improvement and benchmarking activity. Frankston Hospital ICU has participated in 3 of the 4 surveys, and the results have assisted in identifying areas for further research and investigation around our feeding and nutrition care practices. The observational data collected globally as part of the international nutrition surveys has indicated that adequate nutrition plays a role in reducing mortality and increasing ventilator-free days.
The Early Nasojejunal Tube to meet Energy Requirements in Intensive Care (ENTERIC) study compared early nasojejunal nutrition delivered via a spontaneously migrating frictional nasojejunal tube, to continued nasogastric nutrition in mechanically ventilated adults who had elevated gastric residual volumes within 72 hrs of intensive care unit admission. This study showed that in patients with mildly elevated gastric residual volumes and already receiving enteral nutrition, early nasojejunal nutrition did not increase energy delivery and did not appear to reduce the frequency of pneumonia.
The Speech Pathology Team provide 5 day a week services to the ICU ward. The speech pathology clinicians work in the unit on weekdays, together with the multidisciplinary team to:
- Support communication for patients with complex communication needs,
- Facilitate patient weaning from tracheostomy tubes, and;
- Dysphagia management: assessment and management of swallowing problems
Communication Support for Patients with Complex Communication Needs
Our primary role in supporting patients with complex communication needs largely focuses on patients with a tracheostomy that remain ventilated. This is done through assessment of communication needs and communication abilities to meet individual patient needs and facilitate effective communication between the patient to the team and loved ones.
Facilitate Weaning from Tracheostomy Tubes
Together with the multidisciplinary team the Speech Pathology Team facilitate the weaning from a tracheostomy tube. This is achieved through thorough assessment and management of swallowing and communication function.
Our primary role in dysphagia management is to support patients with swallowing difficulties safely transition to oral intake and prevent dysphagia related aspiration. This is done through thorough assessment of oro-motor function, clinical swallowing assessments and ensuring follow-up assessment is completed on patient discharge to the wards.