ICU checklist and quality indicators for NABH accreditation preparation

ICU is a type of specialized wards for providing intensive care to patient in critical condition. It plays an important role in providing quality healthcare and there are several standards applicable to it under NABH. Since it is a ward, all requirements mentioned in the post on ‘In-patient wards checklist and Quality Indicators for NABH accreditation’ is also applicable to it. In addition, following points should be taken care of while preparing ICU for NABH accreditation.

1. Restricted entry to ICU. There should be an demarcation from where entry should be restricted to ICU staff only.
2. Hand washing (or hand rub) at the entry of ICU. Staff must wash their hands or use hand rub before entering ICU and after coming out of it
3. Nurse : Patient ratio to be maintained at 1:1 in all shift. 
4. Nurses in ICU should be trained in intensive nursing care and monitoring
5. ICU should be under the charge of an intensivist or a doctor qualified for providing intensive care
6. All staff in ICU should have Basic Cardiac Life Support (BCLS) skills. At-least one doctor of ICU in each shift should have Advanced Cardiac Life Support (ACLS) skills.
7. Admission and discharge criteria should be followed for admitting or discharging a patient from ICU. ICU in-charge and consultants of hospital must be aware of the criteria.
8. Nurses should know their part of admission and discharge criteria
9. Necessary life-saving and monitoring equipment must be available in working condition in ICU. A list of such equipment must be decided by the hospital.
10. All equipment in ICU should be calibrated bearing the label of their calibration status.
11. ICU Staff should know hospital’s policy on what to do in case of bed shortage in ICU.  
12. Staff should have very good awareness of infection control practices. In addition to standard precautions, ICU staff must also know the care bundles to be followed for patients on ventilator, urinary catheter, central line catheter and post-surgical patients
13. Staff should know the indicators used for measuring quality of ICU care
14. Staff should know hospital’s policy and processes on end of life care
15. Staff should know hospital’s process on care of dead body

Quality Indicators specific to ICU: All quality indicators mentioned in ‘In-patient wardschecklist and Quality Indicators’ are also applicable to ICU. In addition, following quality indicators can be used for ICU

1. ICU specific HAI rates (VAP, CA-UTI, CA-BSI, SSI)
2. Standardized mortality rate
3. Incidence of accidental removal of tubes
4. Average length of stay
5. Compliance percentage to admission-discharge criteria
6. ICU re-admission rate
7. Re-intubation rate

Other checklist of importance: Infrastructure checklist for NABH accreditation

All checklists

Note: There could be additional requirements depending upon type of hospital and its existing situation.

The checklist is open for improvement. Please suggest, if you think any important point has been missed.

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