Governance Requirements
Admission and refusal criteria Handover Discharge criteria Transport Infection prevention and control Antibiotic stewardship Patient blood management Morbidity and mortality Admission and refusal criteria The ICU should have written admission and refusal criteria. These should include guidelines specifying when patients are too well or too sick for ICU and are thus unlikely to benefit from
Admission and refusal criteria
Infection prevention and control
Admission and refusal criteria
The ICU should have written admission and refusal criteria. These should include guidelines specifying when patients are too well or too sick for ICU and are thus unlikely to benefit from ICU admission. There should be a documented process for dispute resolution regarding admission or refusal decisions.
Handover
Nursing and medical handover should follow a prescribed format. This should include a minimum dataset to be included in the handover.
Discharge criteria
The ICU should have written discharge criteria and step-down pathways.
Transport
The ICU should have a written transport protocol for both transfers into the ICU and for ICU patients that require transport for investigations or interventions. This protocol should include minimum vital parameters/maximum support levels for safe transfer and minimum equipment, monitoring, and personnel required for safe transport.
Infection prevention and control
The ICU should be represented on the institutional infection prevention and control (IPC) committee. Furthermore, the ICU should have written IPC protocols including, inter alia, ventilator-associated pneumonia and catheter-related blood stream infection prevention protocols. Hospital-associated infection rates in the ICU should be monitored, and appropriate audits and interventions performed where required.
Antibiotic stewardship
The ICU should be represented on the institutional antibiotic stewardship committee. The prevalence of drug-resistant organisms and the antibiotic resistance profile of the unit should be known and updated regularly (at least every six months). The ICU must have an antibiotic prescribing protocol that incorporates current antibiotic stewardship principles.
Patient blood management
The ICU should be represented on the institutional patient blood management committee. There should be a written ICU protocol for the use of blood and blood products that incorporates current patient blood management principles, especially restrictive transfusion strategies. This protocol should align with relevant national guidelines (notably the CCSSA patient blood management guidelines) (22).
Morbidity and mortality
The ICU should hold regular morbidity and mortality meetings (quarterly at a minimum). These meetings should be multidisciplinary and should focus on identifying and correcting potentially preventable factors that led to morbidity or mortality. The meetings should be non-punitive to allow for frank and open discussion. Minutes should be kept of these meetings, which should record a summary of the discussion, the consensus points reached and the action plan. Participants in these meetings should abide by a clear code of conduct adopted by the unit or institution.
Critical Care Society of Southern Africa Guidelines for the Provision of Critical Care Services in South Africa - Critical Care Society of Southern Africa - Version 1: July 2022