Medical Surgical Intensive Care Unit (MSICU)Family Guide

4th Floor, Cardinal Carter Wing North

MSICU direct line416-864-5286

Table of contents

Welcome to MSICU ........................................................................................... 3

Family presence ................................................................................................. 4

Team rounds ........................................................................................................ 8

Sharing information with the health care team ......................................... 10

Stopping the spread of infections ................................................................. 11

The visitor’s lounge ........................................................................................... 12

Caring for yourself ............................................................................................. 13

Moving out of the ICU ...................................................................................... 14

Other resources ................................................................................................. 15

Share your experience ...................................................................................... 16

Common medical terms ................................................................................... 17

MSICU contact numbers .................................................................................. 23

3

Welcome to MSICU

MSICU stands for Medical Surgical Intensive Care Unit. We care for very sick patients who need to be watched closely or who need some form of life support.

Life support can include:

• Medicines to help a patient’s heart

• A machine called a ventilator to help them breathe

• Dialysis that runs 24 hours a day

Here is how we make sure that patients get the support they need:

• Each nurse in the MSICU cares for 1 to 2 patients.

The MSICU team talks every day about how to care for each patient. We do this during team rounds.

4

Family presence

At St. Michael’s Hospital, we use the word family to mean a patient’s family and anyone else that they feel close to emotionally. It is up to the patient to decide who is considered family and how they will be involved in care and decision-making.

How do I enter the MSICU?

When you arrive, please use the telephone at either entrance, even if the door is open. You can also call in from the phone in the Visitors Lounge. A volunteer can also help you get into the unit. Volunteers are available in the Visitors Lounge from 10 a.m. to 8 p.m.

Please stay at your family member’s bedside. This helps to respect the privacy of other patients.

Are there guidelines for family presence?

Please make sure that only 2 visitors are at the bedside.

At any time of day, family and visitors may be asked to leave the bedside for a certain period of time. This could be to provide treatment and care to your family member, to protect the privacy of other patients, to ensure safety, to help patients rest, or at the patient’s request. For example, if a room is overcrowded or too noisy, staff may ask some family members to wait in the waiting area or to leave the unit for a specific period of time.

5

After 10 p.m.

Quiet hours are from 10 p.m. to 6:30 a.m. This is a time for patients to get sleep and rest. We also encourage visitors to get rest during this time. But, if you would like to stay during these hours, 1 person may stay with your family member. In special situations the care team may allow more than 1 family member to stay at the bedside during Quiet Hours.

If you enter the hospital after 10 p.m., please go to the security desk at the Queen Street Entrance. Security will call the MSICU and you will get a temporary badge to wear.

If you are already in the MSICU at 10 p.m. and want to stay longer, please speak to your family member’s nurse. They will give you a visitor’s badge.

Shift changes

The MSICU can be very busy at shift change. We may ask you to wait outside the unit during this time.

Shift change happens between 7 and 8 a.m. and between 7 and 8 p.m. It is best to visit outside of these times.

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Can I help with patient care?

We want you to share how you would like to participate in your family member’s daily care. A nurse or social worker will ask you how you would like to help.

• Do you want to help him/her bathe?

• Do you want to comb his/her hair?

• Do you want to shave your family member?

• Or are you most comfortable holding his/her hand or sit by their side?

Please feel free to share your ideas.

Where can I leave patient belongings and valuables?

Please do not leave any of your family member’s personal belongings, such as their wallet or jewelry, at the hospital. Do not ask the MSICU to store anything that belongs to your family member.

When your family member was admitted, their valuables were taken to the Cash Office on 1 Donnelly South. We also added a list of their valuables to their chart. Please pick up your family member’s valuables as soon as you can. St Michael’s Hospital is not responsible for lost or stolen items.

7

Can I use my cell phone in MSICU?

Short calls (up to 5 minutes) are allowed in the MSICU. For longer calls, please use the Visitor’s Lounge, coffee shop, or Marketeria.

While in St. Michael’s Hospital, please do not use cameras or video recording devices to respect the privacy of our patients, staff, and visitors. If you would like to take a picture, or an audio or visual recording, please speak with a member of the health care team first.

There may be times when cell phones are not allowed, for example to prevent the spread of infection.

While at St. Joseph’s, please refrain from using camera, video or audio recording devices to respect

patient, staff and visitor privacy.

Ask before you snap

St. Joseph’s Security of Information and Confidentiality Policy, Privacy Policy, Cellular Telephones and Other Wireless Communication Devices Policy

While in the hospital, please refrain from using camera, video or audio

recording devices to respect patient, staff and visitor privacy.

8

Team rounds

Team rounds are when the medical team goes around the MSICU and talks about each patient. Team rounds happen Monday to Friday in the morning, usually at 9 a.m.

The team includes doctors, nurses, residents, pharmacists, dietitians and respiratory therapists (RTs). During team rounds, the team discusses:

• The patient’s medical condition

• The plan for the patient that day

St. Michael’s Hospital is a teaching hospital. Team rounds are an important part of how we teach. During team rounds, new trainees learn from the doctor and senior trainees. This means that the team may talk about more than your family member’s condition. They may talk about other diagnoses and diseases. It does not mean that your family member has every condition the team discusses.

On weekends team rounds usually only include 1 or 2 doctors. They will read each patient’s chart and talk with the nurse who cares for the patient.

Can I participate in team rounds?

During team rounds, you can stay with your family member if you are:

• The substitute decision maker (SDM)

• Someone identified by the SDM who the patient considers as family

During team rounds, you may listen to the discussion. If you have questions or need more information, please tell the doctor or nurse. They will arrange for you to meet with a doctor.

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What if I cannot be there for team rounds?

We understand that you may not always be able to be at the bedside during team rounds. To get an update, call the MSICU or talk to the nurse or doctor the next time you visit.

What should I do if the team is talking about another patient?

We need to protect the privacy of each patient. If the team is getting ready to talk about a patient next to your family member, please:

• Go to the Visitors Lounge

or

• Use the earphones on your electronic device (such as a smart phone or tablet) and listen to music or watch a movie

10

Sharing information with the health care team

We depend on families to give us information about your family member. Here are some of the things we need from you:

• How your family member would like to be called and which pronouns to use (she/he/they)

• Your family member’s medical history

• A list of medicines they are taking

• A copy of the power of attorney, living will or advance medical directives signed by your family member

The nurse will ask you to name one contact person. This person will call us or take phone calls from us. They can then let family and friends know how your family member is doing.

Please fill out a “My Story” sheet. It helps us learn more about your family member. Ask a nurse or social worker for more information.

11

Stopping the spread of infections

Please wash your hands before and after each visit. Hand sanitizer is located at the bedside and at the doors to MSICU.

Please do not visit if you:

• Are coughing

• Are sneezing

• Have a fever

• Have nausea, vomiting or diarrhea

If your family member is on contact, droplet or airborne precautions, ask the nurse how to protect yourself and others when you are visiting.

12

The Visitors Lounge

The Visitors Lounge is on the 4th floor of the Cardinal Carter Wing. This is a shared space among units. In the lounge you can use:

• A small fridge

• A locker for your valuables (bring your own lock and only use for up to 24 hours – locks will be cut after this time)

Please do not leave valuables unattended. St Michael’s Hospital is not responsible for any lost or stolen items.

If you have a large group of family and friends, please consider using one of these areas:

• Marketeria (6th floor Cardinal Carter Wing, open during the day)

• Second Cup at the Queen Street entrance (open 24 hours a day)

Hospital Wi-Fi

Free wi-fi can be accessed by adding SMH_Guest to your wi-fi network list in the settings section of your electronic device. No password is needed.

13

Caring for yourself

While your family member is in the MSICU, it is important for you to get enough rest and take care of yourself.

Do you want to talk to someone about your wellbeing? Your social worker can offer support.

Spiritual care is available to patients and families 24 hours a day, 7 days a week. Ask a member of the MSICU team to contact Spiritual Care for you. If you want to pray or meditate, there is a Chapel and a Multi-faith Meditation Room in the Bond Wing, 3rd floor, room 3-006.

Treating others with respect

The hospital needs to be a safe place for all patients to receive treatment and for all staff to provide care. To make this happen, all health care workers, patients and visitors must treat each other with respect.

The following is not tolerated:

• Swearing or disrespectful language

• Being disruptive, loud, or rude

• Physically or verbally aggressive or threatening behaviour

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Moving out of the ICU

Moving to another unit

It is difficult to predict how soon a patient can move out of the MSICU. Most patients can be transferred when they do not need as much specialized care. Talk to your team about helping you prepare for the move and what you can expect. You can also see the “Leaving the MSICU” brochure for more information.

Please note

We may move your family member within the unit or to another ICU. This is to meet the care needs of all our patients.

If your family member needs to be moved to another ICU, the MSICU team will let you know.

Moving to another hospital

Repatriation refers to the process of transferring a patient back to their referring hospital or to a hospital closer to the patient’s home. If your family member came to St. Michael’s Hospital from another hospital for specialized care, you will return to a hospital closer to home once that specialized care is complete and it is safe. Please see the “Care Closer to Home” brochure for more information.

15

Other resources

For more information about hospital services, please see the Patient and Visitor Information Handbook, available in the visitor’s lounge.

Additional brochures on the following topics are available in the visitor’s lounge:

Clostridium Difficile

Methicillin-Resistant Staphylococcus Aureus (MRSA)

Vancomycin-Resistant Enterococci (VRE)

Carbapenemase-Producing Enterobacteriaceae (CPE)

Tuberculosis

Handwashing

Advance Care Planning

Substitute Decision-Making

Power of Attorney - Personal Care

Informed Consent

Delirium

Physical Restraints

Blood transfusion

Pressure Sores

Cystic Fibrosis

Family Meeting

Patient and Visitor Information Handbook

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The ICU Patient Communicator App

The Society of Critical Care Medicine (SCCM) has an app that helps patients who are awake but unable to talk. It helps them communicate about issues like pain, comfort, and well-being in different languages. The app also has information and resources for patients and their families.

Share your experience

Before you leave the hospital, we will invite you to do an online survey. Please tell us about your experiences in the MSICU.  You can also fill in a comment card. These are available in the Visitor’s Lounge or from the health care team. Your feedback helps us to improve the care we provide to patients and families at St. Michael’s Hospital.

Patient and family advisors

Patient and family advisors (PFAs) share ideas and feedback on patient and family experience to help us improve. You can help make a huge difference by becoming a PFA today. To learn more please contact an Experience & Engagement Specialist at PFA@smh.ca

17

Common medical terms

You may hear many new medical terms while your family member is in MSICU. We hope that this alphabetical list can help you understand what is happening.

Ambu-bag – A device used to push air into a patient’s lungs when they are not breathing or not breathing enough on their own.

Apnea – The patient has stopped breathing for a short time.

Art line – Short for arterial line. A small tube put into a patient’s artery to monitor their blood pressure constantly. Most art lines are in the wrist, inside elbow or groin. These are called radial, brachial and femoral art lines. We may also use the art line to take blood samples.

Bagging – Pushing 100% oxygen into a patient’s lungs using an ambu-bag. Bagging helps the patient get enough oxygen. Sometimes the RT, nurse or doctor also does suctioning to help the patient get enough oxygen.

Bed spacing – You may hear this term when we are moving a patient to another ICU. All the ICU’s at St. Michael’s hospital provide the same standard of care.

Brady – Short for bradycardia. This is when the patient’s heart rate is under 60 beats per minute.

Cardiac monitor – A screen by the patient’s bedside that shows the patient’s heart rate, heart rhythm, blood pressure and breathing.

Central line – This is a large IV line used to give medicines that cannot go through an IV in the arm. Central lines are in big veins such as the veins in the neck, groin, or below the collarbone. A PICC is one type of central line.

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Charge nurse – The nurse on every shift who is in charge for that shift. The charge nurse is responsible for overseeing everything that is happening in the unit.

CPR – Short for cardio-pulmonary resuscitation. CPR is also known as chest compressions. CPR is the first thing nurses do when the patient’s heart stops beating.

CRRT – Short for continuous renal replacement therapy. CRRT is a form of dialysis that runs 24 hours a day. CRRT is a form of life support and is only provided in ICU units.

Delirium – A sudden state of confusion that can make a patient hallucinate or be agitated and restless. Delirium can be caused by some medicines and by disturbed sleep patterns.

Dialysis – A process where a machine helps the kidneys “clean” the blood and remove fluid from the body.

DNR – Short for ‘do not resuscitate’. When patients come into MSICU we ask about their wishes in case their heart stops. DNR is one of their choices. If a patient asks for DNR, then we do not provide CPR if their heart stops. There are different variations of a DNR status. For example, a patient who asks for DNR can still get full medical care, including intubation and special medications but no CPR.

ETT – Short for endotracheal tube. An ETT is also called a breathing tube. An ETT helps patients breathe. It is a tube that goes in through the patient’s mouth, through the trachea and into the lungs. When a patient has a breathing tube, we say that they are intubated.

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Fellow – A doctor who has finished medical school and a specialty training program and is now taking more specialized training.

Full code –This means that we will provide full medical care including CPR, defibrillation and life support in case their heart stops.

Intubated – When a patient has a breathing tube or ETT in their lungs to help them breathe.

Life support – Any form of medication, infusion or machine that the patient needs to live. Some examples include a ventilator, pressors/inotropes and CRRT.

MAP – Short for mean arterial pressure. The MAP helps the team know if enough blood is flowing to the patient’s organs.

NGT or OGT – Short for nasal gastric tube or oral gastric tube. These tubes go into a patient’s stomach. Patients who cannot swallow, who are intubated, trached, or on a ventilator need these tubes to get nutrition (such as Ensure) and take medicines. If the tube goes through the nose it is a nasal gastric tube (NGT). If it goes through the mouth it is an oral gastric tube (OGT).

NPO – Stands for ‘nothing by mouth’. This is when a patient cannot eat by mouth or cannot have any form of nutrition in their stomach.

O2 sats – Short for oxygenation saturation. This number tells the health care team how much oxygen is in the patient’s blood.

Optiflow – High flow oxygen that is given through the nose or through a trach mask.

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PICC – Short for Peripherally Inserted Central Catheter. A central line that is put into the patient’s arm and goes into a big vein. PICC lines are used if patients need IV for a long time.

POA – Short for power of attorney for personal care. This is a legal document where one person gives another person the authority to make decisions about their personal and medical care if they can no longer make decisions for themselves.

Pressors or Inotropes – These are medicines that are given through an IV to keep the patient’s blood pressure up and to help their heart work better.

Repatriation – The process of transferring patients from St. Michael’s Hospital to their referring acute care hospital or an acute care hospital that is closer to their home.

Resident – A doctor who has completed medical school and is in a training program to become a specialist in a specific area (for example in internal medicine, surgery or anesthesia).

Room Air – This means that the patient does not need any extra oxygen. Room air contains 21% oxygen. This is the percentage of oxygen that is in the air we all breathe.

SBT – Short for spontaneous breathing trial. This is a test conducted on patients on ventilators by the RT to see if the patient can safely breathe without the help of a ventilator.  The ventilator settings are lowered to imitate what it would be like if the patient did not have the breathing tube in.

SDM – Short for substitute decision maker. An SDM is a person who can make treatment decisions on behalf of the patient when the patient is not able to make their own decisions. The SDM may be the patient’s POA, their spouse, child or another relative.

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Sepsis – An overwhelming and life-threatening response to an infection in the body. Sepsis can damage tissues and lead to organ failure.

Suctioning – What we do if the patient cannot cough up mucous on their own. Suctioning is important because if mucous sits in a patient’s lungs or airway, it can keep the patient from getting enough oxygen and can increase the risk of infections. The health care team can suction through the patient’s ETT, trach, mouth or nostril.

Tachy – Short for tachycardia. This is when the heart rate is over 100 beats per minute.

Team Rounds – This is the time every morning when the health care team discusses each patient’s case. The team talks about what brought the patient to ICU, what is preventing them from getting better and what can be done to help them get better.

TPN – Short for total parental nutrition. This means that the patient gets all of the nutrition they need through an IV line. Patients who cannot have any form of nutrition in their gastrointestinal tract need TPN to stay alive.

Trach – Short for tracheostomy. A trach is a hole in the patient’s neck to let air into the patient’s trachea. A trach gives patients a long-term airway so that they can breathe, with or without a ventilator.

Trach mask – When a patient has a trach and is off the ventilator we use this type of mask. The mask sits over the patient's trach to provide oxygen.

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Trach mask trials – When a patient with a trach is being weaned off of the ventilator. The team will take the patient off the ventilator and put an oxygen mask over the patient’s trach. The team will see how long the patient is comfortable breathing without the ventilator. Once the patient gets tired, the team will put the patient back on the ventilator. The team will continue to do this until the patient can breathe all the time without the ventilator.

Vascath – This is a large tube that is in a major vein and is used for dialysis.

Vent or Ventilator – A breathing machine used when a patient who has a breathing tube (ETT) or a trach needs extra help with their breathing.

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MSICU contact numbers

Ellen Lewis Clinical Leader Manager 416-864-6060 extension 2191

Christine LeeSocial Worker416-864-6060 extension 3800

Rose Piacentino/Kristy BuckSocial Worker416-864-6060 extension 4146

Notes:

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70114 Rev. Jul29 2019 V3

30 Bond Street, Toronto, ON M5B 1W8 Canada416.864.6060 stmichaelshospital.com

St. Michael’s cares about your health. For reliable health information, visit our Patient and Family Learning Centre, or find us online at www.stmichaelshospital.com/learn

This information is not intended as a substitute for professional medical care. Ask your healthcare provider about this information if you have questions.