Intensive Care Unit (ICU), information for family and friends
This information has been written to answer some of the questions you may have when a member of your family or a close friend has been admitted to the Intensive Care Unit (ICU)/High Dependency Unit (HDU).
Please feel free to ask any questions at any time. We would also welcome any suggestions you may have to improve our service.
All the staff working in intensive care are dedicated to providing healthcare of the highest possible standard. We will provide care in such a way as to respect the dignity, privacy and confidentiality of each patient and his or her family.
We aim to treat each patient as an individual and act as the patient’s advocate, in conjunction with family and significant others.
Contact information
Intensive Care Unit- Chelsea and Westminster Hospital
T: 020 3315 4331
Intensive Care Unit- West Middlesex University Hospital
T: 020 8321 5833
Admission to the Intensive Care Unit (ICU)/High Dependency Unit (HDU)
A patient whose condition is extremely serious, possibly life-threatening, is often taken to an Intensive Care Unit (ICU) which provides constant observation and treatment from specially trained staff qualified to use specialised equipment.
Some admissions to the ICU are planned, usually after major surgery or in order for specialist treatments to be performed.
In such cases it may be possible to visit the unit beforehand or speak with staff working in pre-operative assessment. This can help you and your relative or friend by showing you the environment of an ICU in advance. However, most admissions are in emergency situations.
You may also hear the unit referred to as ITU—that stands for Intensive Therapy Unit. It means the same as ICU.
Our units are combined ICU and High Dependency Unit (HDU). HDUs are for patients who require less monitoring or treatment than is normally provided in an ICU.
Due to clinical need, men and women are nursed next to each other on the unit—the staff will endeavour to maintain your relative’s or friend’s dignity at all times.
When you or your relative or friend is discharged they will either go to a side room or a single sex bay on a ward.
Technology in the ICU
The Intensive Care Unit uses machines which can look frightening when seen for the first time. These machines help us to monitor and support a patient’s normal body functions.
Each patient is attached to a machine called a cardiac monitor. Small, sticky pads are placed on the patient’s chest and are connected to a machine.
The machine picks up electrical impulses from a patient’s heart and can detect any abnormalities. The monitor can also show a patient’s blood pressure and temperature. It is normal for the numbers on the monitor to keep changing.
Patients who are not strong enough to breathe on their own will be connected to a ventilator (breathing machine). This is attached to a tube passing through the nose or mouth into the windpipe. The tube, which is known as an endotracheal tube, is connected to a machine that blows air and extra oxygen in and out of the lungs.
The machine can ‘breathe’ completely for a patient or it can be set to assist a patient’s own breathing. Patients can be gradually weaned off a ventilator when their condition improves.
If a patient is likely to remain on a ventilator for more than a few days, the endotracheal tube is sometimes replaced with a tracheostomy. In this case an operation is carried out to insert a tube into a hole made in the throat. Although this can look quite strange, it is actually more comfortable for the patient than having a tube in their mouth.
Please remember that, although unable to speak, your relative or friend may be able to hear you. By all means do talk to them, but questions should be put so that they can be answered with a nod or shake of their head.
Patients are often attached to drips or infusions. These allow liquids to be passed through tubes into veins, usually in the side of the neck, arm or hand.
There are various substances commonly used in drips. Fluids can be used for various reasons including rehydration and maintenance of blood pressure. A pump is attached to the drip to administer the drugs at the correct rate.
Food, in the form of liquid, containing essential nutrients can be given either through the nose via a tube which goes down into the stomach, or by using a drip.
Your relative or friend will have a urinary catheter in order to empty their bladder. We measure the urine every hour so that we can assess how the kidneys are working.
Many of the machines have alarms and flashing lights. They go off quite often for a variety of reasons. Please do not be frightened by the lights or noises. The alarms are to attract the attention of the staff.
The nurse will be happy to explain the equipment to you. There is also a folder in the waiting room entitled Equipment in ICU. Please ask questions if you don’t understand something or would like to know more.
Always ask for clarification if jargon or technical terms are used. Staff working on the unit are used to this language and we sometimes forget how baffling and frightening it can be for other people.
Can I help?
Some of the drugs will keep a patient deeply asleep. However, you should always assume that the patient can hear you and understand everything that you are saying.
Do feel free to talk to your relative or friend. Do not be afraid to touch your relative or friend. It may be comforting for both of you.
While your relative or friend is in intensive care you may want to help with the care being given. This could involve simple mouth care or helping to wash your relative or friend. This would be done under the supervision of a nurse.
The nurse will be able to advise and discuss this with you.
The ICU team
There is a photo board in the corridor into the unit which shows the ICU team.
All staff wear scrubs which are changed after each shift. Everyone will be wearing identification as it may be difficult to know if someone is a doctor, nurse, therapist or other member of the ICU team. Everyone on the unit should introduce themselves to you but please ask if you are unsure.
Medical team
On the unit we have ICU consultants who provide cover for the unit 24/7. You may be introduced to different consultants during your friend’s or relative’s stay, however they will have been given an in-depth handover of your friend’s or relative’s condition. The consultant is supported by a team of specialist registrars and core trainees.
Nursing team
Nursing care is provided by our team of about ICU nurses. Each nurse is a member of one our nursing teams.
When your relative or friend is admitted to the unit, they will be cared for by a primary nursing team. This approach allows us to get to know the patient and you better. It also helps you to get to know the nurses caring for your relative or friend.
Continuity of care
Every effort is made to ensure patients receive high quality care from the nursing teams. There may be occasions when a member of the team may not be on duty. If this occurs, a nurse from another team will care for your relative or friend for the shift. At times it may be necessary for a non-team member to make decisions about care in collaboration with others, due to the patient’s condition. The primary nurse will be made aware of these changes on their return.
The unit consists of intensive care and high dependency beds. In intensive care, one nurse cares for one patient whereas in high dependency, one nurse cares for two patients.
Physiotherapists
There is a physiotherapy service for all patients on the ICU. A team of physiotherapists will assess each patient on a daily basis to identify any areas that may benefit from treatment.
This may include:
- Listening to the chest and clearing the lungs
- Maintaining a range of limb movements and mobility in bed, such as stretches and splinting
- Strengthening exercises and facilitating mobility, such as transferring to a chair and aiding walking
It may come as a surprise to some people that while patients are so unwell they have physiotherapy—however it is at this time that it is so important for patients to be stimulated, as this plays a vital part in the recovery process.
Not every patient will require the same amount of input—some patients will just have a daily review, whereas others may receive treatment several times a day. It is the role of the physiotherapist to determine how much input is appropriate for each patients. Sometimes it is useful to get relatives to encourage and help carry out exercises with the patient.
The same physiotherapist working in ICU will initially continue to treat patients when they move to the ward but, as the patient improves, other teams may be more involved in the ongoing rehabilitation.
If you have any questions regarding the physiotherapy service for patients on ICU, please speak to the nurse in charge who will contact the physiotherapy team.
Critical Care Outreach Team
This is a group of specialised nurses who are trained in critical care and provide a link between patients on the ward and the ICU.
Radiographer
The radiographer takes images of the patient’s chest using a portable X-ray machine. Most patients have a daily X-ray in the morning to check either their lungs or the placement of specialised lines.
Pharmacist
In ICU patients receive a lot of drugs. The role of the pharmacist is to ensure that patients are given appropriate medicines, the unit has an adequate supply, and to answer any questions staff have relating to medications.
Dietitian
The dietitian plays a vital role in ensuring the patient receives adequate calories to fight infection and their critical illness. They will visit daily to check on patients.
Speech and Language Therapist
The role of the Speech and Language Therapist in intensive care is to assess and treat eating and swallowing problems that critically ill patients may have. They also help with communication.
Technician
The ICU has a lot of equipment. The technician’s role is to look after the equipment, train staff on its use, and replace devices when they expire or are damaged.
These are only a small number of the many staff who work within the multidisciplinary team to provide expert care to your relative or friend.
Psychology
ICU can be at times difficult to cope with. We have a psychology team that can help support you with and your relative during their stay in ICU.
A day in intensive care
The day is planned as much as possible around the individual needs of your relative or friend. There is a basic structure to the day:
7:45–10am: Nursing and medical staff hand over from the night shift to the day shift. In this time the intensive care team meets to review each patient’s condition and decide any changes in treatment.
10am–4pm: Each patient’s individual plan of care will be carried out during this time. This may include physiotherapy, further tests on or outside the ICU, changes to drips and tubes, or assessments and care by other members of our multidisciplinary team.
5–6pm: Evening rounds to review the conditions of all our patients.
7:45–8:15pm: Night shift nurses start work.
Visiting the unit
Security intercom
On arrival to the unit you will find an intercom system outside the entrance. Press the buzzer and, when someone answers, please say who you are and who you are visiting. It sometimes takes a while to answer the buzzer if the nurses are busy. Please be patient.
At times you may have to wait before coming into the area where patients are being cared for.
There is a waiting room available for your use. There are many aspects of care which have to be done around the clock and waiting is sometimes unavoidable.
Infection control
Infection control is extremely important in the ICU and there are a number of ways you can help us in this area:
- Please ensure you clean your hands on entering and leaving the unit by either washing your hands or using the alcohol hand gel placed around the unit
- Please do not handle any lines or tubing
- Refrain from sitting on patients’ beds
- Do not bring flowers or plants into the unit
- Keep patients’ property to a minimum
- Do not bring young babies into the unit—however, in exceptional circumstances, please discuss this with the nurse in charge.
Please speak to a staff member if you have any queries about infection control issues.
Visiting times
Visiting times are from 10am–10pm. Please speak to the nurse in charge if you need to visit outside of these hours, the team are always flexible.
You may be asked to leave during visiting times to allow for patient care or during ward rounds to ensure confidentiality.
Too many visitors at one time can be very tiring for patients. We ask that this is limited to a maximum of two to three visitors at the bedside.
Please respect the privacy and confidentiality of other patients in the unit. All patients have the right to this.
If your relative or friend is in ICU for a long time, you may find that visiting becomes harder. It is quite normal to feel helpless because it seems there is nothing you can do.
You could pass the time by reading aloud from a favourite book or a newspaper, if your friend or relative is unconscious.
It can be helpful for you to have someone to talk to. A hospital chaplain can visit or they can arrange for a representative of a specific faith or belief to come and see you.
Visiting can be very tiring. It is understandable to be worried about your relative or friend but it is important to take care of yourself. Try to rest properly and don’t forget to eat sensibly.
Young visitors
Children are welcome. If you feel unsure about this, discuss it with the nursing staff. We would also advise you to bring in something to occupy them during the visit.
Transport/parking
There are public transport options and a car park under the hospital—full details are on the Trust website.
The hospital has limited parking in the hospital car park and queues can occur from late morning to early afternoon.
Close relatives of patients in the unit are able to park free of charge. Ask the nursing staff to fill in a form when you leave. You must present this signed form to security at the main reception before leaving the hospital.
Gifts and presents
Most patients in the unit are not able to eat or drink normally. Please check with the nurse before bringing in food and drink.
Flowers and plants are not allowed on the unit as they can spread infection to our patients.
We would suggest:
- Toiletries
- Personal music devices
- Photographs and cards from family
Clothing and property
There is limited storage space for personal property. While patients are in ICU they are not likely to need many items, however glasses and hearing aids are helpful in keeping people orientated.
If your relative or friend comes from home or another ward with property, you may be asked to take non-essential items home for safekeeping. If property is kept on ICU it will be recorded on a property form—please ask a nurse for a copy of this.
When patients start to get better and have less monitoring, it is nice for them to be able to wear their own clothes. A nurse may ask you to bring some in.
Cash, credit cards and jewellery should never be left at the hospital. Your own personal property should never be left unattended when you are visiting.
Making enquiries
We ask that the family or friends of the patient nominate one person who can phone the unit and pass the information on. This will save us repeating the same information to many different people.
At times it may be necessary to restrict the information we give on the phone to maintain patient confidentiality.
If you would like to talk to the doctor, please ask a member of staff and this can be arranged.
The direct line telephone numbers are:
- Chelsea and Westminster 020 3315 4331
- West Middlesex 020 8321 5833
Using mobile phones
You are able to use your mobile phone but we ask that you restrict this to non-clinical areas only.
If you need to charge your mobile phone, please ask a member of staff first.
Filming or taking photographs of patients or members of staff without their permission is strictly prohibited.
Refreshments
Chelsea and Westminster
Costa Coffee (Ground Floor, Lift Bank B) is open 24/7.
The hospital restaurant (Lower Ground Floor, Lift Bank D) is open Mon–Fri,
There are shops, bars and restaurants along Fulham Road.
West Middlesex Hospital
Costa Coffee (Ground Floor, Lift Bank B) is open during the day.
The hospital restaurant (Ground Floor,) is open Mon–Fri
There are also shops on the ground floor.
Facilities
Banks
Chelsea and Westminster
A cashpoint is at the front of the hospital (immediately on the right as you exit) as well as in front of Tesco (which is open 24/7) just over the road.
West Middlesex
A cashpoint is at the front of the hospital in M&S.
Toilets
Both ICU’s have toilet facilities for visitors by the waiting areas.
Chaplaincy service
The multi-faith chaplaincy offers support to patients and visitors of all faiths or none to help with their spiritual and religious needs.
For a place of quiet, prayer and reflection we have the following available:
at Chelsea and Westminster hospital.
the chapel is on the 1st Floor, Lift Bank C, and the Islamic tent is on the 4th Floor, Lift Bank D
At west Middlesex the chapel is on the ground floor
Please speak to a member of staff if you would like to see a chaplain. The chaplaincy team is happy to make visits and can also arrange visits by ministers of other faiths and beliefs.
Interpreting service
We are able to book professional interpreters for patients or families who speak English as a second language.
This service is provided by the Trust without charge to our patients or their families.
Going to the ward
The consultant will decide when your relative or friend is able to be discharged from ICU to a ward. Your relative or friend will be seen by the critical care outreach team, who will continue to see them once they have moved to a ward.
If a patient dies
The purpose of an ICU is to treat seriously ill patients and hopefully help them recover. In some cases, however, despite all our best efforts, a patient will not recover.
In these situations the doctors may need to discuss the appropriateness of further treatment. Doctors are usually able to prepare those concerned if their relative or friend is approaching a critical stage.
Organ donation
It may be possible for a patient who has died to become an organ donor. Organ donation is an option if a patient on a ventilator suffers brain-stem death.
It may also be possible for body tissue to be donated within 24 hours of death.
You may find that organ donation is a positive outcome even in the midst of grief, particularly if you know it is something your relative or friend would have wanted.
The staff can talk to you about the possibilities of donation.
After a death
The death of someone close to you can leave feelings of anger, numbness, tiredness and helplessness, as well as deep sadness. Coming to terms with your loss can be a long process and it is perfectly natural for it to take time.
You will be given a copy of the Trust’s bereavement service guide. In this booklet there is practical information, advice and a list of organisations you can contact for additional support.
You will also need to make an appointment with the bereavement officer—they, too, can offer advice and answer any queries.
Tell us what you think
It is important that any problems are dealt with quickly, at an early stage. Please talk to the staff on duty if you have any concerns.
If you feel unhappy about the way we have handled your concern please talk to the Matron in intensive care.
A relatives’ satisfaction survey is available for you to fill in. These are accessed via a QR code. There are posters on the ICU with the QR code.
The surveys enable us to act on any suggestions you may have to improve our service.
Glossary of ICU terms
When you are in ICU you will inevitably hear terms or abbreviations that are unfamiliar to you. This is a short list of the most common ones.
Blood gas machine—a machine which measures the blood gases.
Blood gases—a blood test to check the level of oxygen, carbon dioxide and acidity which may be done several times a day.
Carbon dioxide (CO2)—the waste gas eliminated by the lungs.
Catheter—used to empty a patient’s bladder.
CCU/ICU/ITU—Intensive Care Units can be referred to by various names which mean the same thing, for example Critical Care Unit (CCU), Intensive Care Unit (ICU) or Intensive Therapy Unit (ITU). The unit cares for patients with acute illness or injury that require specialised procedures and treatments by specialised staff.
Central line—a line that is inserted into the patient in order for liquids/drugs to be passed into their veins.
Critical Care Team—a team of health professionals who care for critically ill and injured patients. It includes predominantly a critical care intensivist and a critical care nurse, but may also include physiotherapists, pharmacists, technicians, social workers and clergy.
Endotracheal tube—a tube which is inserted through either the patient’s nose or throat into the windpipe and is sometimes referred to as an ET tube.
Intensivist—a critical care physician whose medical practice is focused entirely on the care of critically ill and injured patients.
PO2—Blood oxygen level.
Pulse oximeter—a probe that wraps around a finger or toe, connected to a machine, which measures how much oxygen the blood is carrying.
Speaking valve—this allows a patient with a tracheostomy to use their voice and is only used as the patient’s condition improves.
Suction—mechanical removal of mucous from the nose, throat or endotracheal tube with a plastic tube.
Tracheostomy—a tracheostomy (or ‘trachy’) is a tube inserted into the windpipe via a hole in the patient’s throat. This sounds very daunting and can look strange, but it is much more comfortable for patients and means they can be awake.
Ventilator—also known as a breathing machine, this piece of equipment blows air and oxygen in and out of the lungs. The breathing machine can do all the breathing for the patient or it can assist the patient’s own breathing.
Weaning—the process of taking a patient off the ventilator once they are able to breathe on their own.