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New NICE standards on critical illness rehab care

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Nurses involved in transferring patients from critical care to general wards should have a “formal handover”, state proposed new national clinical standards.

Critical care patients should also have rehabilitation goals agreed within four days of being admitted to hospital, under the proposals.

Draft standards describing high quality rehabilitation in the wake of critical care have been published by the National Institute for Health and Care Excellence.

The draft standard outlines key areas of care for improvement when a patient has experienced a level 2 or level 3 critical care stay.

However, NICE noted that it did not cover specific conditions like head injury, myocardial infarction and stroke, as these are covered by other published quality standards.

This draft quality standard outlines four quality statements, including that teams have a formal handover when patients are transferring to a general ward from critical care, such as from an intensive care ward.

NICE stated that healthcare professionals – nurses and doctors from critical care and the general ward – should work together “using a formal process to handover the individualised, structured rehabilitation programme for adults transferring from critical care to a general ward”.

In addition, they highlight having rehabilitation goals agreed within four days of being admitted to and before discharge from critical care if the patient is at risk of a physical morbidity, such as muscle loss, or a non-physical morbidity like cognitive dysfunction.

Healthcare professionals with experience in critical care and rehabilitation should agree both short- and medium-term rehabilitation goals and ensure are agreed with the patient, if possible, or family or carers.

They also promote giving patients information about what to expect after they leave hospital and having a formal review with patients who have been identified as having rehabilitation needs two to three months after they are discharged from critical care.

A consultation on the draft quality standard will be open until 21 April with the final version due in August.

NICE quality statements

Statement 1 – Adults in critical care who are at risk of physical and non-physical morbidity have short- and medium-term rehabilitation goals agreed within four days of being admitted to and before discharge from critical care

Statement 2 – Adults transferring from critical care to a general ward have a formal handover of their individualised structured rehabilitation programme

Statement 3 – Adults who have been in critical care and are discharged from hospital are given information about what to expect after discharge

Statement 4 – Adults with rehabilitation needs identified from a functional assessment have a review two to three months after their discharge from critical care.

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