Transfer to high dependency care

Undertaking a risk assessment for transferring will identify the need for appropriate staff, the length of time it will take and any anticipated risks to patient safety. 's daughter will need to be aware of her admission to HDU. Consider each of these issues.

Continuous ECG monitoring

Emergency equipment

Documentation

Medications

Oxygen cylinder

Appropriate level of trained staff

Continuous ECG monitoring

This is essential where the patient's condition is deteriorating. A continuous reading of ECG and oxygen saturations can alert the transfer team to potential problems as quickly as possible. It is important to continue to record vital signs during a long transport (e.g. if delayed by waiting for lifts).

Emergency equipment

This is essential to take. This should include suction equipment, a selection of oral airways, laryngeal masks and tracheal tubes, self-inflating bag and mask with oxygen reservoir. Whilst may not currently require intubation and ventilation, her condition could potentially deteriorate quickly.

Documentation

's medical and nursing documentation needs to be taken to ensure effective handover of the situation for her and continuity of recording vital signs and fluids. This allows changes seen in the journey to be documented. Continuing to record vital signs is essential.

Medications

An array of emergency medicines needs to be taken with the means of giving these.

Ensure no critical treatment is outstanding. For example, administering antibiotics in someone who is diagnosed with high (red) risk sepsis is deemed to be a critical medication and is not appropriate to be handed over for administration following transfer. They should be given without delay.

Oxygen cylinder

An oxygen cylinder with sufficient oxygen for the duration of the journey is required. You may need to calculate what size of oxygen cylinder to take to ensure you have plenty to cope with an emergency occurring.

Appropriate level of trained staff

The people who transport to HDU need to have an appropriate level of training, so the knowledge and skills to be able to cope with any situation that arises during transport.

A practitioner who can give intravenous medications is essential. It may be appropriate to have either a nurse prescriber (e.g. nurse practitioner) or a clinician experienced in intubation and emergency situations also present during transfer.

Ideally two intravenous cannulae should be sited prior to transfer to allow for administration of medications. Ensure all medications given during transfer are prescribed and recorded according to your local policy.

Observations Medicines Fluid Balance Blood Results

Continuous ECG monitoring

Show 's current charts

Emergency equipment

Show 's current charts

Documentation

Show 's current charts

Medications

An array of emergency medicines needs to be taken with the means of giving these.

Show 's current charts

Oxygen cylinder

Show 's current charts

Appropriate level of trained staff

The people who transport to HDU need to have an appropriate level of training, so the knowledge and skills to be able to cope with any situation that arises during transport.

Show 's current charts

MEDICINE PRESCRIPTION AND ADMINISTRATION RECORD
WARD Emergency Dept. WARD __________ WARD __________			CONSULTANT ____________________		DATE OF ADMISSION		NAME: AGE: HOSPITAL NUMBER: NHS NUMBER:
Card No 1 of 1		Chart rewritten By _____________ Date ________________________ Pharmacy check By _____________ Date ________________________			Weight _______(kg) Date ____________ Weight _______(kg) Date		NAME: AGE: HOSPITAL NUMBER: NHS NUMBER:
DRUG ALLERGY or ADVERSE EFFECT Medicine/Other Signature				If none know tick box [✔] Effect Date This section must be completed and signed by a prescriber or Pharmacist
ONCE ONLY MEDICINES
Date	Medicine	Dose	Route	Administration Instructions	Time Required	Prescriber's Sig, Print Name & Bleep	Time Given	Given By	Checked By	Pharm
	Tazocin	4.5g	I.V.	Give Immediately	18.00	A.BRN 1234	18.15	JE	AM
	Salbutamol	2.5mg	neb		18.00	A.BRN 1234	18.15	JE	AM
	Atrovent	500mg	neb		18.00	A.BRN 1234	18.15	JE	AM

REGULAR PRESCRIPTIONAlways check allergy box before prescribing or administering

Antimicrobial
Co-amoxiclav

Date

Review required

Circle/Enter times

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Review medications, prescribe again if needed
Decision: (circle)

stop
change
extend course
refer to ...
other ...

CJ/HS

Dose
500mg

Route
I.V.

Start date

Diagnosis/Indication
pneumonia / sepsis

Pharmacy

Intended duration (days)

Signature

Print (name and bleep)
A.BRN 1234

CJ/HS

Antimicrobial
Clarithromycin

Date

Review required

Circle/Enter times

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Review medications, prescribe again if needed
Decision: (circle)

stop
change
extend course
refer to ...
other ...

CJ/HS

Dose
500mg

Route
I.V.

Start date

Diagnosis/Indication
pneumonia / sepsis

Pharmacy

Intended duration (days)

Signature

Print (name and bleep)
A.BRN 1234

GL/AD 20:50

Patient Details Patient Name: Age: Hospital Number:				FLUID CHART DATE: WARD: Emergency Dept.
INPUT (mLs)						OUTPUT (mLs)
Time	Intravenous fluid	Other (write)	DRUG (write) Noradrenaline	Hourly total	Running total	Urine	Hourly total	Running total	Balance (+ve or -ve)
01:00
...
18:00	500					++ incontinent
19:00	500	30 (tazocin)		1030	1030				+ve 1030
20:00	500, 500			1000	2030				+ve 2030
21:00	(maintenance) 82		(2mL/hr) 2	84	2114	50 (residual)	50	50	+ve 2064
22:00
23:00
24:00

Patient Details Patient Name: Age: Hospital Number:				FLUID CHART Part One \| Part Two DATE: WARD: Emergency Dept. PREVIOUS DAY'S BALANCE: +ve 2533
INPUT (mLs)						OUTPUT (mLs)
Time	Intravenous fluid	Other (write)	DRUG (write) Noradrenaline	Hourly total	Running total	Urine	Hourly total	Running total	Balance (+ve or -ve)
01:00	250		10	260	260	30	30	30	+ve 230
02:00	250		10	260	520	35	35	65	+ve 455
03:00	250		10	260	780	40	40	105	+ve 675
04:00	250		10	260	1040	15	15	120	+ve 920
05:00	250	500 Hartman's	10	760	1800	25	25	145	+ve 1655
06:00	250		10	260	2060	30	30	175	+ve 1885
07:00	250		10	260	2320	30	30	205	+ve 2115
08:00	250		10	260	2580	20	20	225	+ve 2355
09:00	250		10	260	2840	10	10	235	+ve 2605
...

Haematology and CoagulopathyClinical Chemistry and Liver Function Tests
Test	Normal Values	18:30	20:15	06:00
HB	11.5 - 16.5 g/dL	10.0	9.8
Platelets	150 - 450 x 10^-9/L	120	114
WBC	4.0 - 11.0 x 10^-9/L	14.0	14.8
MCV	84 - 102 fL	85	84
Neutrophils	2.0 - 7.5 x 10^-9/L	9.0	9.2
ESR	1 - 20
APTT Ratio	0.85 - 1.14
INR	0.8 - 1.2
Prothrombin Time	10.0 - 12.0 sec's	12	12
APTT	21.0 - 29.0 sec's	32	32
Thrombin Time	17.0 - 21.0 sec's	21	21
D-Dimer	0 - 250 µg/L	200	202
Fibrinogen	1.8 - 4.0 g/L

Clinical Chemistry and Liver Function TestsHaematology and Coagulopathy
Test	Normal Values	18:30	20:15	06:00
Sodium	134 - 145 mmol/L	140	138
Potassium	3.5 - 5.3 mmol/L	4.5	4.2
Urea	2.9 - 7.5 mmol/L	10.0	10.2
Creatinine	45 - 84 µmol/L	100	104
GFR	(ml/min)
Glucose	4.0 - 8.0 mmol/L	9.9	8.9
Amylase	0 - 110 U/L
CK	25 - 200 U/L
ALT	0 - 35 U/L	30	35
γGT	0 - 40 U/L	50	48
Bilirubin	0 - 21 µmol/L	40	45
Alk Phosphate	40 - 130 U/L	180	183
Albumin	30 - 50 g/L	24	18
CRP	0 - 10 mg/dL	110	121
Troponin	up to 0.1 µg/L
Bicarbonate	24 - 32 mmol/L
Calcium	2.2 - 2.6 mmol/L
Phosphate	0.8 - 1.45 mmol/L
Magnesium	0.7 - 1.0 mmol/L

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Transfer to high dependency care

Continuous ECG monitoring

Emergency equipment

Documentation

Medications

Oxygen cylinder

Appropriate level of trained staff

Handover from Emergency Department