Guidelines and standards​

Browse below for ICS guidelines and standards written and recognised by UK experts in their respective fields. They are coordinated by our Joint Standards Committee in conjunction with the Faculty of Intensive Care Medicine.


Harm from misplaced nasogastric intubation tube


Patients are continuing to be harmed from misplaced nasogastric intubation (NG) tubes due to misinterpretation of chest x-rays (CXRs). This is despite a number of national safety alerts over the last decade and its inclusion as a never event. The learning from a recent incident has been shared by the ICU involved, and is available on to read here.

Units must ensure that all staff who interpret CXRs for NG tube placement have completed competency based training and use the recommended four-point criteria.

An online training package is also available at eLearning for Health (https://portal.e-lfh.org.uk).
SBAR NGT Never Event
(Adobe PDF File)

Safety Checklists for Invasive Procedures


National Safety Standards for Invasive Procedures (NatSSIPs) cover all invasive procedures, which can be defined as procedures that require piercing the skin to gain access to the inside of a patient’s body, or gaining access to a body cavity without cutting into the body, or using electromagnetic radiation (laser eye treatments).

Local Safety Standards for Invasive Procedures (LocSSIPs) have arisen from a framework document produced by NHS England’s Patient Safety Domain and the NatSSIPs group to promote safe practice locally. The aim is to build on the positive aspects of the WHO Safer Surgery Checklist acknowledging that checklists alone are not enough to ensure patient safety. A team trained in this area with safe practice at the forefront of their thinking would reinforce best practice and improve patient safety.

NatSSIPs guidelines outline the key elements for the development of LocSSIPs including: governance, documentation, handovers, briefing, procedural verification, and sign in and out. As each institution will have their own approach to invasive procedures, an overarching, inflexible, centrally driven dictat was not appropriate.

Therefore, FICM and ICS Joint Standards Committee have produced, in collaboration with Ged Smith at the Walton Centre in Liverpool, a set of WHO style checklists for the following procedures:

  • Percutaneous tracheostomy
  • Intubation
  • Central line insertion
  • Bronchoscopy
  • Chest drain
  • NG insertion

These have been designed to give any institution, which hasn’t yet created localised guidelines, a starting point to develop their own hospital specific LocSSIPs. The checklists will obviously require relevant educational and clinical governance to accompany their use in the clinical workplace and again the intention is for this to be developed to fit in with local working practices and staffing.

The checklists can be downloaded by clicking on the links below:

The care of the critically ill woman in childbirth


The care of the critically ill woman in childbirth; enhanced maternal care 2018 summarises recommendations relevant to the care of pregnant or recently pregnant, acutely or chronically unwell women, who require acute hospital maternity and critical care specialist services. The development of this document has been led by the Obstetric Anaesthetists' Association (OAA). It is published jointly by the Royal College of Anaesthetists (RCoA), Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives (RCM), Intensive Care Society (ICS), Faculty of Intensive Care Medicine (FICM) and OAA.

This document replaces the former Joint Standing Committee 2011 standards providing equity of critical and maternity care for the critically-ill pregnant or recently pregnant woman document.

Guidelines On The Management Of Acute Respiratory Distress Syndrome


ICS/FICM Guideline Development Group have used GRADE methodology to make the following recommendations for the management of adult patients with acute respiratory distress syndrome (ARDS).The British Thoracic Society supports the recommendations in this guideline.


Appendix A - PRISMA Diagrams
(Adobe PDF File)

Devastating Brain Injury

Twelve practical, pragmatic recommendations to help clinicians deliver safe, effective, equitable and justifiable care to patients with perceived devastating brain injury:

Eye Care in the Intensive Care Unit (ICU)

This document aims to provide advice and information for clinical staff who are involved in eye care in the ICU.

Resources to support safer care for patients at risk of autonomic dysreflexia


This alert asks providers to use the signposted resources to review local clinical policy and guidance relating to bowel assessment and management. They should review local training and education provision, particularly around the care of patients with spinal cord injury or neurological conditions that have led to neurogenic bowel dysfunction.

Resources to support safer bowel care for patients at risk of autonomic dysreflexia


GPICS

GPICS can be used as the definitive reference source for planning and delivery of UK Intensive Care Services. Download here:

Safety and Shared Learning


You can find further  information via the FICM site here .

Manual bolus dose of insulin
(Adobe PDF File)
vascath-stylet-fault
(Adobe PDF File)

Specific guidelines

Due for review

 

The guidelines below have been recognised as needing a review by the Joint Standards Committee