Transitioning out of ICU
Post ICU Syndrome (PICS)
- ICU-acquired weakness
- ICU polyneuromyopathy
- Pulmonary dysfunction
- Post-traumatic stress syndrome
- Difficulties with executive function, attention, and memory
- Decreased quality of life
- Problems with self-care
- Difficulty returning to work or social activities
- Economic hardship on patients and families
N-SPADESS: Model of care in ICU
The QCH ICU adheres to the N-SPADESS model of care. Prioritization is placed on several NSPADES elements of care, initiation and monitoring is the responsibility of the ICU interdisciplinary team. While determining and managing the underlining condition, key elements such as Nutrition, Sedation, agitation, delirium prevention, sleep, and early mobility are also the focus of patients care while in the ICU. Research shows this model of care aids in prevention of Post-ICU syndrome (PICS).
N - Nutrition
S - Sedation
P - Pain management
A - Agitation management
D - Delirium prevention
E - Early mobilization
S - Sleep
S - Supports
Before leaving the ICU
As you start to get better, you will not need the machines that were helping to support your body's normal functions and monitoring your condition. The physiotherapist will probably give you exercises to help strengthen your muscles to get you moving around again. You will be very weak and get tired easily at first. As you become able to do more for yourself, you may be moved to a different section of the ICU or transferred to another ward in the hospital with a reduced level of nursing.
Moving to a General Ward/Floor
This can be a difficult time for patients and relatives because there is no longer the one-to-one nursing that there was in the early stages, but you are still far from being well. You may need to re-learn how to do simple things such as walking, eating, drinking, or even breathing for yourself. This can be frightening but is normal at this time in your recovery.
From this time you will be cared for by the ward staff, but they will be able to talk to the ICU staff if they need to. You will be followed by the Rapid Response Team, you may be visited by an ICU(RRT) nurse while you're on the ward to check on your progress. The visiting times in a general ward may not be as flexible as they are in the ICU and you may be disturbed more by other patients and visitors around you. Your normal sleep pattern may be upset due to the constant activity while you were in the ICU. This does return to normal in time. Rest when you can. You may find that a personal music player with headphones helps you to relax and pass the time.
When you get home
You won't have the same support you had in hospital and it can be a difficult time for you and for your relatives. It's normal to go through times where you feel depressed or frustrated because you don't seem to be getting better. Setting small goals in your daily routine can help you recover and show you that you are improving. A small goal could be something as simple as making a drink for yourself, or walking a few steps further without needing to rest. Don't push yourself too hard as this can end up making your recovery take longer. When you've been critically ill, you'll probably feel very tired and won't have much energy. It will take time before you feel well enough to cope with everyday life and many more months to get back to full strength. Set yourself targets to help you get back to normal, and keep doing the exercises your physiotherapist gave you. Don't overdo your exercise as this can set your recovery back. You will need to slowly increase your activity to build up your strength, but make sure that you rest when you need to. In the early days you may need to take things very slowly. If you've had an operation, you must follow your surgeon's advice. Your body will tell you if it's getting tired or is in pain. If you feel unwell or get out of breath, stop what you're doing and rest.