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["An Excel tool kit for the Guidelines for the Provision of Intensive Care Services V2, 2019."]
[]
[]
[]
["Introduction"]
["In June 2019, the Intensive Care Society (ICS) and Faculty of Intensive Care Medicine (FICM) released the second edition of Guidelines for the Provision of Intensive Care Services (GPICS). The first edition of GPICS (2015) built on the earlier Core Standards for Intensive Care Units (2013) and has become the definitive reference source for the planning, commissioning and delivery of Adult Critical Care Services in the UK. Many units have found the GPICS standards and recommendations to be invaluable in developing successful business cases to enhance their local services and improve patient care. GPICS has also been used as the benchmark by which local services are peer reviewed and assessed by healthcare regulators, such as the Care Quality Commission (CQC).\nThe ICS and FICM have worked in collaboration to develop this tool kit to help individual units to compare their services to the latest version of GPICS. The standards and recommendations are presented in Excel format with a drop down option of ‘met’, ‘partially met’, ‘unmet’ or ‘not applicable to this service’ next to each guideline. The tool kit also allows units to produce a PDF summary page which provides a useful overview of their responses."]
["This tool kit is not stand-alone and should be used alongside the full GPICS document which is available via the link below. We recommend that the toolkit is completed in collaboration with members of the multi-disciplinary team, so that each section is completed by individuals who are best placed to make an accurate assessment. We are aware that defining compliance with standards and recommendations is difficult and have deliberately left this to the judgment of local clinicians and managers.\nWe see the further development of this tool kit as an iterative process, working with individuals and networks to improve and refine its functionality. If you have any suggestions or comments please contact us at info@ics.ac.uk.\nWe hope you find this tool kit useful."]
["Click the following link to see the full GPICS document online: ",null,null,null,null,"https://bit.ly/GPICSTool",null,null,"or double click on the embedded PDF (you may need to switch to Windows to view after opening) >"]
[]
["Click here to view the Instructions sheet"]
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["© Intensive Care Society and Faculty of Intensive Care Medicine."]

{"sheet":"Instructions","index":1,"n_rows":19,"n_cols":6,"rows_kept":19,"cut":false,"hidden":false,"merged":[[6,3,6,9],[8,3,8,4],[11,0,11,12],[15,0,15,8],[18,0,18,12],[7,3,7,9]]}
["An Excel tool kit for the Guidelines for the Provision of Intensive Care Services V2, 2019."]
[]
[]
[]
["Instructions"]
["1. To add your unit name to the summary page please enter it here:"]
["Critical care unit name:"]
["Operational Delivery Network (ODN) /Region"]
["Date (dd/mm/yyyy)"]
[]
["2. Filling in the sheet"]
["Do not fill anything in on summary of scores sheet. On every other sheet, every box that is blue requires a number to be inputted as follows:"]
["0 =  Not met  1 = Partially met  2 = Fully met  ",null,null,null,null,"3 = Not Applicable to your ICU"]
[]
["3. Navigating the sheets"]
["To get to a sheet either click on the sheet name tab at the bottom of the screen, or from the Summary of scores, click on the text that you want to go to."]
[]
["4. Creating a PDF"]
["To create a PDF summary of the gap analysis of your ICU click on the button below (macros must be enabled for it to work). "]

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[null,"Summary of the gap analysis of your ICU compared to the GPICS v2  Report date: ",null,null,null,null,null,null,null,"Hidden","Hidden","Hidden","Hidden","Hidden","Hidden","Hidden","Hidden","Hidden","Hidden","Hidden"]
[null,null,null,null,null,null,null,null,null,"NotMet","PartiallyMet","FullyMet","NotMet","PartiallyMet","FullyMet"]
["Section","Description","STANDARDS",null,null,"RECOMMENDATIONS",null,null,"Complete","STANDARDS",null,null,"RECOMMENDATIONS",null,null,"STANDARDS","RECOMMENDATIONS","Total count","N/A","Total count incl N/A"]
[null,null,"Not Met","Partly Met","Fully Met","Not Met","Partly Met","Fully Met"]
[1,"CRITICAL CARE SERVICES: STRUCTURE"]
[1.1000000000000001,"Levels of Critical Care",{"$f":"IFERROR(J6/$P6,\"-\")","v":0},0,0,{"$f":"IFERROR(M6/$Q6,\"-\")","v":0},0,0,{"$f":"IF(AND(SUM(J6:O6)=SUM(P6:Q6),T6=R6+S6),1,0)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A6,'Critical Care Services Structur'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A6,'Critical Care Services Structur'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A6,'Critical Care Services Structur'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A6,'Critical Care Services Structur'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A6,'Critical Care Services Structur'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A6,'Critical Care Services Structur'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,P$3,'Critical Care Services Structur'!$F:$F,$A6)-COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A6,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":2},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,Q$3,'Critical Care Services Structur'!$F:$F,$A6)-COUNTIFS('Critical Care Services Structur'!$E:$E,K$3,'Critical Care Services Structur'!$F:$F,$A6,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":1},{"$f":"SUM(P6:Q6)","v":3},{"$f":"COUNTIFS('Critical Care Services Structur'!$F:$F,$A6,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,P$3,'Critical Care Services Structur'!$F:$F,$A6)+COUNTIFS('Critical Care Services Structur'!$E:$E,Q$3,'Critical Care Services Structur'!$F:$F,$A6)","v":3}]
[1.2,"Outcomes",{"$f":"IFERROR(J7/$P7,\"-\")","v":0},0,0,{"$f":"IFERROR(M7/$Q7,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A7,'Critical Care Services Structur'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A7,'Critical Care Services Structur'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A7,'Critical Care Services Structur'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A7,'Critical Care Services Structur'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A7,'Critical Care Services Structur'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A7,'Critical Care Services Structur'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,P$3,'Critical Care Services Structur'!$F:$F,$A7)-COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A7,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":4},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,Q$3,'Critical Care Services Structur'!$F:$F,$A7)-COUNTIFS('Critical Care Services Structur'!$E:$E,K$3,'Critical Care Services Structur'!$F:$F,$A7,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":3},{"$f":"SUM(P7:Q7)","v":7},{"$f":"COUNTIFS('Critical Care Services Structur'!$F:$F,$A7,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,P$3,'Critical Care Services Structur'!$F:$F,$A7)+COUNTIFS('Critical Care Services Structur'!$E:$E,Q$3,'Critical Care Services Structur'!$F:$F,$A7)","v":7}]
[1.3,"Level 2 and 3 Physical Facilities",{"$f":"IFERROR(J8/$P8,\"-\")","v":0},0,0,{"$f":"IFERROR(M8/$Q8,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A8,'Critical Care Services Structur'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A8,'Critical Care Services Structur'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A8,'Critical Care Services Structur'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A8,'Critical Care Services Structur'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A8,'Critical Care Services Structur'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A8,'Critical Care Services Structur'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,P$3,'Critical Care Services Structur'!$F:$F,$A8)-COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A8,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":3},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,Q$3,'Critical Care Services Structur'!$F:$F,$A8)-COUNTIFS('Critical Care Services Structur'!$E:$E,K$3,'Critical Care Services Structur'!$F:$F,$A8,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":8},11,{"$f":"COUNTIFS('Critical Care Services Structur'!$F:$F,$A8,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,P$3,'Critical Care Services Structur'!$F:$F,$A8)+COUNTIFS('Critical Care Services Structur'!$E:$E,Q$3,'Critical Care Services Structur'!$F:$F,$A8)","v":11}]
[1.4,"Clinical Information Systems",{"$f":"IFERROR(J9/$P9,\"-\")","v":0},0,0,{"$f":"IFERROR(M9/$Q9,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A9,'Critical Care Services Structur'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A9,'Critical Care Services Structur'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A9,'Critical Care Services Structur'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A9,'Critical Care Services Structur'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A9,'Critical Care Services Structur'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A9,'Critical Care Services Structur'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,P$3,'Critical Care Services Structur'!$F:$F,$A9)-COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A9,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":5},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,Q$3,'Critical Care Services Structur'!$F:$F,$A9)-COUNTIFS('Critical Care Services Structur'!$E:$E,K$3,'Critical Care Services Structur'!$F:$F,$A9,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":10},15,{"$f":"COUNTIFS('Critical Care Services Structur'!$F:$F,$A9,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,P$3,'Critical Care Services Structur'!$F:$F,$A9)+COUNTIFS('Critical Care Services Structur'!$E:$E,Q$3,'Critical Care Services Structur'!$F:$F,$A9)","v":15}]
[1.5,"Clinical Equipment",{"$f":"IFERROR(J10/$P10,\"-\")","v":0},0,0,{"$f":"IFERROR(M10/$Q10,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A10,'Critical Care Services Structur'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A10,'Critical Care Services Structur'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A10,'Critical Care Services Structur'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A10,'Critical Care Services Structur'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A10,'Critical Care Services Structur'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A10,'Critical Care Services Structur'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,P$3,'Critical Care Services Structur'!$F:$F,$A10)-COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A10,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":16},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,Q$3,'Critical Care Services Structur'!$F:$F,$A10)-COUNTIFS('Critical Care Services Structur'!$E:$E,K$3,'Critical Care Services Structur'!$F:$F,$A10,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":2},18,{"$f":"COUNTIFS('Critical Care Services Structur'!$F:$F,$A10,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,P$3,'Critical Care Services Structur'!$F:$F,$A10)+COUNTIFS('Critical Care Services Structur'!$E:$E,Q$3,'Critical Care Services Structur'!$F:$F,$A10)","v":18}]
[1.6,"Cardiothoracic Critical Care",{"$f":"IFERROR(J11/$P11,\"-\")","v":0},0,0,{"$f":"IFERROR(M11/$Q11,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A11,'Critical Care Services Structur'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A11,'Critical Care Services Structur'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A11,'Critical Care Services Structur'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A11,'Critical Care Services Structur'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A11,'Critical Care Services Structur'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A11,'Critical Care Services Structur'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,P$3,'Critical Care Services Structur'!$F:$F,$A11)-COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A11,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":11},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,Q$3,'Critical Care Services Structur'!$F:$F,$A11)-COUNTIFS('Critical Care Services Structur'!$E:$E,K$3,'Critical Care Services Structur'!$F:$F,$A11,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":6},17,{"$f":"COUNTIFS('Critical Care Services Structur'!$F:$F,$A11,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,P$3,'Critical Care Services Structur'!$F:$F,$A11)+COUNTIFS('Critical Care Services Structur'!$E:$E,Q$3,'Critical Care Services Structur'!$F:$F,$A11)","v":17}]
[1.7,"Neurocritical Care",{"$f":"IFERROR(J12/$P12,\"-\")","v":0},0,0,{"$f":"IFERROR(M12/$Q12,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A12,'Critical Care Services Structur'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A12,'Critical Care Services Structur'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A12,'Critical Care Services Structur'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A12,'Critical Care Services Structur'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A12,'Critical Care Services Structur'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,M$3,'Critical Care Services Structur'!$F:$F,$A12,'Critical Care Services Structur'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,P$3,'Critical Care Services Structur'!$F:$F,$A12)-COUNTIFS('Critical Care Services Structur'!$E:$E,J$3,'Critical Care Services Structur'!$F:$F,$A12,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":11},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,Q$3,'Critical Care Services Structur'!$F:$F,$A12)-COUNTIFS('Critical Care Services Structur'!$E:$E,K$3,'Critical Care Services Structur'!$F:$F,$A12,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":9},20,{"$f":"COUNTIFS('Critical Care Services Structur'!$F:$F,$A12,'Critical Care Services Structur'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Critical Care Services Structur'!$E:$E,P$3,'Critical Care Services Structur'!$F:$F,$A12)+COUNTIFS('Critical Care Services Structur'!$E:$E,Q$3,'Critical Care Services Structur'!$F:$F,$A12)","v":20}]
[]
[2,"CRITICAL CARE SERVICE: WORKFORCE"]
[2.1,"Medical Staffing",{"$f":"IFERROR(J15/$P15,\"-\")","v":0},0,0,{"$f":"IFERROR(M15/$Q15,\"-\")","v":0},0,0,{"$f":"IF(AND(SUM(J15:O15)=SUM(P15:Q15),T15=R15+S15),1,0)","v":0},{"$f":"COUNTIFS('Critical Care Services Workforc'!$E:$E,J$3,'Critical Care Services Workforc'!$F:$F,$A15,'Critical Care Services Workforc'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Workforc'!$E:$E,J$3,'Critical Care Services Workforc'!$F:$F,$A15,'Critical Care Services Workforc'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Workforc'!$E:$E,J$3,'Critical Care Services Workforc'!$F:$F,$A15,'Critical Care Services Workforc'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Workforc'!$E:$E,M$3,'Critical Care Services Workforc'!$F:$F,$A15,'Critical Care Services Workforc'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Workforc'!$E:$E,M$3,'Critical Care Services Workforc'!$F:$F,$A15,'Critical Care Services Workforc'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Workforc'!$E:$E,M$3,'Critical Care Services Workforc'!$F:$F,$A15,'Critical Care Services Workforc'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Workforc'!$E:$E,P$3,'Critical Care Services Workforc'!$F:$F,$A15)-COUNTIFS('Critical Care Services Workforc'!$E:$E,J$3,'Critical Care Services Workforc'!$F:$F,$A15,'Critical Care Services Workforc'!$D:$D,NotApplicable)","v":11},{"$f":"COUNTIFS('Critical Care Services Workforc'!$E:$E,Q$3,'Critical Care Services Workforc'!$F:$F,$A15)-COUNTIFS('Critical Care Services Workforc'!$E:$E,Q$3,'Critical Care Services Workforc'!$F:$F,$A15,'Critical Care Services Workforc'!$D:$D,NotApplicable)","v":2},{"$f":"SUM(P15:Q15)","v":13},{"$f":"COUNTIFS('Critical Care Services Workforc'!$F:$F,$A15,'Critical Care Services Workforc'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Critical Care Services Workforc'!$E:$E,P$3,'Critical Care Services Workforc'!$F:$F,$A15)+COUNTIFS('Critical Care Services Workforc'!$E:$E,Q$3,'Critical Care Services Workforc'!$F:$F,$A15)","v":13}]
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[]
[3,"CRITICAL CARE SERVICES: PROCESS"]
[3.1,"Admissions, Discharge and Handover",{"$f":"IFERROR(J30/$P30,\"-\")","v":0},0,0,{"$f":"IFERROR(M30/$Q30,\"-\")","v":0},0,0,{"$f":"IF(AND(SUM(J30:O30)=SUM(P30:Q30),T30=R30+S30),1,0)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A30,'Critical Care Services Process'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A30,'Critical Care Services Process'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A30,'Critical Care Services Process'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,M$3,'Critical Care Services Process'!$F:$F,$A30,'Critical Care Services Process'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,M$3,'Critical Care Services Process'!$F:$F,$A30,'Critical Care Services Process'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,M$3,'Critical Care Services Process'!$F:$F,$A30,'Critical Care Services Process'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,P$3,'Critical Care Services Process'!$F:$F,$A30)-COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A30,'Critical Care Services Process'!$D:$D,NotApplicable)","v":11},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,Q$3,'Critical Care Services Process'!$F:$F,$A30)-COUNTIFS('Critical Care Services Process'!$E:$E,Q$3,'Critical Care Services Process'!$F:$F,$A30,'Critical Care Services Process'!$D:$D,NotApplicable)","v":1},{"$f":"SUM(P30:Q30)","v":12},{"$f":"COUNTIFS('Critical Care Services Process'!$F:$F,$A30,'Critical Care Services Process'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,P$3,'Critical Care Services Process'!$F:$F,$A30)+COUNTIFS('Critical Care Services Process'!$E:$E,Q$3,'Critical Care Services Process'!$F:$F,$A30)","v":12}]
[3.2,"Capacity Management",{"$f":"IFERROR(J31/$P31,\"-\")","v":0},0,0,{"$f":"IFERROR(M31/$Q31,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A31,'Critical Care Services Process'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A31,'Critical Care Services Process'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A31,'Critical Care Services Process'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,M$3,'Critical Care Services Process'!$F:$F,$A31,'Critical Care Services Process'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,M$3,'Critical Care Services Process'!$F:$F,$A31,'Critical Care Services Process'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,M$3,'Critical Care Services Process'!$F:$F,$A31,'Critical Care Services Process'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,P$3,'Critical Care Services Process'!$F:$F,$A31)-COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A31,'Critical Care Services Process'!$D:$D,NotApplicable)","v":11},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,Q$3,'Critical Care Services Process'!$F:$F,$A31)-COUNTIFS('Critical Care Services Process'!$E:$E,Q$3,'Critical Care Services Process'!$F:$F,$A31,'Critical Care Services Process'!$D:$D,NotApplicable)","v":5},16,{"$f":"COUNTIFS('Critical Care Services Process'!$F:$F,$A31,'Critical Care Services Process'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,P$3,'Critical Care Services Process'!$F:$F,$A31)+COUNTIFS('Critical Care Services Process'!$E:$E,Q$3,'Critical Care Services Process'!$F:$F,$A31)","v":16}]
[3.3,"Critical Care Outreach and Rapid Response Systems",{"$f":"IFERROR(J32/$P32,\"-\")","v":0},0,0,{"$f":"IFERROR(M32/$Q32,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A32,'Critical Care Services Process'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A32,'Critical Care Services Process'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A32,'Critical Care Services Process'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,M$3,'Critical Care Services Process'!$F:$F,$A32,'Critical Care Services Process'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,M$3,'Critical Care Services Process'!$F:$F,$A32,'Critical Care Services Process'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,M$3,'Critical Care Services Process'!$F:$F,$A32,'Critical Care Services Process'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,P$3,'Critical Care Services Process'!$F:$F,$A32)-COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A32,'Critical Care Services Process'!$D:$D,NotApplicable)","v":2},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,Q$3,'Critical Care Services Process'!$F:$F,$A32)-COUNTIFS('Critical Care Services Process'!$E:$E,Q$3,'Critical Care Services Process'!$F:$F,$A32,'Critical Care Services Process'!$D:$D,NotApplicable)","v":7},9,{"$f":"COUNTIFS('Critical Care Services Process'!$F:$F,$A32,'Critical Care Services Process'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,P$3,'Critical Care Services Process'!$F:$F,$A32)+COUNTIFS('Critical Care Services Process'!$E:$E,Q$3,'Critical Care Services Process'!$F:$F,$A32)","v":9}]
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[3.5,"Interaction with Other Services: Microbiology, Pathology, Liaison Psychiatry and Radiology",{"$f":"IFERROR(J34/$P34,\"-\")","v":0},0,0,{"$f":"IFERROR(M34/$Q34,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A34,'Critical Care Services Process'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A34,'Critical Care Services Process'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A34,'Critical Care Services Process'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,M$3,'Critical Care Services Process'!$F:$F,$A34,'Critical Care Services Process'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,M$3,'Critical Care Services Process'!$F:$F,$A34,'Critical Care Services Process'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,M$3,'Critical Care Services Process'!$F:$F,$A34,'Critical Care Services Process'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,P$3,'Critical Care Services Process'!$F:$F,$A34)-COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A34,'Critical Care Services Process'!$D:$D,NotApplicable)","v":6},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,Q$3,'Critical Care Services Process'!$F:$F,$A34)-COUNTIFS('Critical Care Services Process'!$E:$E,Q$3,'Critical Care Services Process'!$F:$F,$A34,'Critical Care Services Process'!$D:$D,NotApplicable)","v":8},14,{"$f":"COUNTIFS('Critical Care Services Process'!$F:$F,$A34,'Critical Care Services Process'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,P$3,'Critical Care Services Process'!$F:$F,$A34)+COUNTIFS('Critical Care Services Process'!$E:$E,Q$3,'Critical Care Services Process'!$F:$F,$A34)","v":14}]
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[3.9,"Staff Support",{"$f":"IFERROR(J38/$P38,\"-\")","v":0},0,0,{"$f":"IFERROR(M38/$Q38,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A38,'Critical Care Services Process'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A38,'Critical Care Services Process'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A38,'Critical Care Services Process'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,M$3,'Critical Care Services Process'!$F:$F,$A38,'Critical Care Services Process'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,M$3,'Critical Care Services Process'!$F:$F,$A38,'Critical Care Services Process'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,M$3,'Critical Care Services Process'!$F:$F,$A38,'Critical Care Services Process'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,P$3,'Critical Care Services Process'!$F:$F,$A38)-COUNTIFS('Critical Care Services Process'!$E:$E,J$3,'Critical Care Services Process'!$F:$F,$A38,'Critical Care Services Process'!$D:$D,NotApplicable)","v":9},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,Q$3,'Critical Care Services Process'!$F:$F,$A38)-COUNTIFS('Critical Care Services Process'!$E:$E,Q$3,'Critical Care Services Process'!$F:$F,$A38,'Critical Care Services Process'!$D:$D,NotApplicable)","v":8},17,{"$f":"COUNTIFS('Critical Care Services Process'!$F:$F,$A38,'Critical Care Services Process'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Critical Care Services Process'!$E:$E,P$3,'Critical Care Services Process'!$F:$F,$A38)+COUNTIFS('Critical Care Services Process'!$E:$E,Q$3,'Critical Care Services Process'!$F:$F,$A38)","v":17}]
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[]
[4,"CRITICAL CARE SERVICES: CLINICAL CARE"]
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[]
[5,"CRITICAL CARE SERVICES: ADDITIONAL COMPONENTS"]
[5.0999999999999996,"Research and Development",{"$f":"IFERROR(J59/$P59,\"-\")","v":0},0,0,{"$f":"IFERROR(M59/$Q59,\"-\")","v":0},0,0,{"$f":"IF(AND(SUM(J59:O59)=SUM(P59:Q59),T59=R59+S59),1,0)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A59,'Additional Components'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A59,'Additional Components'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A59,'Additional Components'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,M$3,'Additional Components'!$F:$F,$A59,'Additional Components'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,M$3,'Additional Components'!$F:$F,$A59,'Additional Components'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,M$3,'Additional Components'!$F:$F,$A59,'Additional Components'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,P$3,'Additional Components'!$F:$F,$A59)-COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A59,'Additional Components'!$D:$D,NotApplicable)","v":1},{"$f":"COUNTIFS('Additional Components'!$E:$E,Q$3,'Additional Components'!$F:$F,$A59)-COUNTIFS('Additional Components'!$E:$E,Q$3,'Additional Components'!$F:$F,$A59,'Additional Components'!$D:$D,NotApplicable)","v":6},{"$f":"SUM(P59:Q59)","v":7},{"$f":"COUNTIFS('Additional Components'!$F:$F,$A59,'Additional Components'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,P$3,'Additional Components'!$F:$F,$A59)+COUNTIFS('Additional Components'!$E:$E,Q$3,'Additional Components'!$F:$F,$A59)","v":7}]
[5.2,"Audit and Quality Improvement",{"$f":"IFERROR(J60/$P60,\"-\")","v":0},0,0,{"$f":"IFERROR(M60/$Q60,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A60,'Additional Components'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A60,'Additional Components'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A60,'Additional Components'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,M$3,'Additional Components'!$F:$F,$A60,'Additional Components'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,M$3,'Additional Components'!$F:$F,$A60,'Additional Components'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,M$3,'Additional Components'!$F:$F,$A60,'Additional Components'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,P$3,'Additional Components'!$F:$F,$A60)-COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A60,'Additional Components'!$D:$D,NotApplicable)","v":5},{"$f":"COUNTIFS('Additional Components'!$E:$E,Q$3,'Additional Components'!$F:$F,$A60)-COUNTIFS('Additional Components'!$E:$E,Q$3,'Additional Components'!$F:$F,$A60,'Additional Components'!$D:$D,NotApplicable)","v":6},11,{"$f":"COUNTIFS('Additional Components'!$F:$F,$A60,'Additional Components'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,P$3,'Additional Components'!$F:$F,$A60)+COUNTIFS('Additional Components'!$E:$E,Q$3,'Additional Components'!$F:$F,$A60)","v":11}]
[5.3,"Clinical Governance",{"$f":"IFERROR(J61/$P61,\"-\")","v":0},0,0,{"$f":"IFERROR(M61/$Q61,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A61,'Additional Components'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A61,'Additional Components'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A61,'Additional Components'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,M$3,'Additional Components'!$F:$F,$A61,'Additional Components'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,M$3,'Additional Components'!$F:$F,$A61,'Additional Components'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,M$3,'Additional Components'!$F:$F,$A61,'Additional Components'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,P$3,'Additional Components'!$F:$F,$A61)-COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A61,'Additional Components'!$D:$D,NotApplicable)","v":10},{"$f":"COUNTIFS('Additional Components'!$E:$E,Q$3,'Additional Components'!$F:$F,$A61)-COUNTIFS('Additional Components'!$E:$E,Q$3,'Additional Components'!$F:$F,$A61,'Additional Components'!$D:$D,NotApplicable)","v":6},16,{"$f":"COUNTIFS('Additional Components'!$F:$F,$A61,'Additional Components'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,P$3,'Additional Components'!$F:$F,$A61)+COUNTIFS('Additional Components'!$E:$E,Q$3,'Additional Components'!$F:$F,$A61)","v":16}]
[5.4,"Critical Care Networks",{"$f":"IFERROR(J62/$P62,\"-\")","v":0},0,0,{"$f":"IFERROR(M62/$Q62,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A62,'Additional Components'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A62,'Additional Components'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A62,'Additional Components'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,M$3,'Additional Components'!$F:$F,$A62,'Additional Components'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,M$3,'Additional Components'!$F:$F,$A62,'Additional Components'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,M$3,'Additional Components'!$F:$F,$A62,'Additional Components'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,P$3,'Additional Components'!$F:$F,$A62)-COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A62,'Additional Components'!$D:$D,NotApplicable)","v":5},{"$f":"COUNTIFS('Additional Components'!$E:$E,Q$3,'Additional Components'!$F:$F,$A62)-COUNTIFS('Additional Components'!$E:$E,Q$3,'Additional Components'!$F:$F,$A62,'Additional Components'!$D:$D,NotApplicable)","v":10},15,{"$f":"COUNTIFS('Additional Components'!$F:$F,$A62,'Additional Components'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,P$3,'Additional Components'!$F:$F,$A62)+COUNTIFS('Additional Components'!$E:$E,Q$3,'Additional Components'!$F:$F,$A62)","v":15}]
[5.5,"Critical Care Commissioning",{"$f":"IFERROR(J63/$P63,\"-\")","v":0},0,0,{"$f":"IFERROR(M63/$Q63,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A63,'Additional Components'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A63,'Additional Components'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A63,'Additional Components'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,M$3,'Additional Components'!$F:$F,$A63,'Additional Components'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,M$3,'Additional Components'!$F:$F,$A63,'Additional Components'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,M$3,'Additional Components'!$F:$F,$A63,'Additional Components'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,P$3,'Additional Components'!$F:$F,$A63)-COUNTIFS('Additional Components'!$E:$E,J$3,'Additional Components'!$F:$F,$A63,'Additional Components'!$D:$D,NotApplicable)","v":4},{"$f":"COUNTIFS('Additional Components'!$E:$E,Q$3,'Additional Components'!$F:$F,$A63)-COUNTIFS('Additional Components'!$E:$E,Q$3,'Additional Components'!$F:$F,$A63,'Additional Components'!$D:$D,NotApplicable)","v":5},9,{"$f":"COUNTIFS('Additional Components'!$F:$F,$A63,'Additional Components'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Additional Components'!$E:$E,P$3,'Additional Components'!$F:$F,$A63)+COUNTIFS('Additional Components'!$E:$E,Q$3,'Additional Components'!$F:$F,$A63)","v":9}]
[]
[6,"CRITICAL CARE SERVICES: EMERGENCY PREPAREDNESS"]
[6.1,"Fire",{"$f":"IFERROR(J66/$P66,\"-\")","v":0},0,0,{"$f":"IFERROR(M66/$Q66,\"-\")","v":0},0,0,{"$f":"IF(AND(SUM(J66:O66)=SUM(P66:Q66),T66=R66+S66),1,0)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,J$3,'Emergency Preparedness'!$F:$F,$A66,'Emergency Preparedness'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,J$3,'Emergency Preparedness'!$F:$F,$A66,'Emergency Preparedness'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,J$3,'Emergency Preparedness'!$F:$F,$A66,'Emergency Preparedness'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,M$3,'Emergency Preparedness'!$F:$F,$A66,'Emergency Preparedness'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,M$3,'Emergency Preparedness'!$F:$F,$A66,'Emergency Preparedness'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,M$3,'Emergency Preparedness'!$F:$F,$A66,'Emergency Preparedness'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,P$3,'Emergency Preparedness'!$F:$F,$A66)","v":10},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,Q$3,'Emergency Preparedness'!$F:$F,$A66)-COUNTIFS('Emergency Preparedness'!$E:$E,Q$3,'Emergency Preparedness'!$F:$F,$A66,'Emergency Preparedness'!$D:$D,NotApplicable)","v":4},{"$f":"SUM(P66:Q66)","v":14},{"$f":"COUNTIFS('Emergency Preparedness'!$F:$F,$A66,'Emergency Preparedness'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,P$3,'Emergency Preparedness'!$F:$F,$A66)+COUNTIFS('Emergency Preparedness'!$E:$E,Q$3,'Emergency Preparedness'!$F:$F,$A66)","v":14}]
[6.2,"Major Incidents",{"$f":"IFERROR(J67/$P67,\"-\")","v":0},0,0,{"$f":"IFERROR(M67/$Q67,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,J$3,'Emergency Preparedness'!$F:$F,$A67,'Emergency Preparedness'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,J$3,'Emergency Preparedness'!$F:$F,$A67,'Emergency Preparedness'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,J$3,'Emergency Preparedness'!$F:$F,$A67,'Emergency Preparedness'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,M$3,'Emergency Preparedness'!$F:$F,$A67,'Emergency Preparedness'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,M$3,'Emergency Preparedness'!$F:$F,$A67,'Emergency Preparedness'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,M$3,'Emergency Preparedness'!$F:$F,$A67,'Emergency Preparedness'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,P$3,'Emergency Preparedness'!$F:$F,$A67)-COUNTIFS('Emergency Preparedness'!$E:$E,J$3,'Emergency Preparedness'!$F:$F,$A67,'Emergency Preparedness'!$D:$D,NotApplicable)","v":7},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,Q$3,'Emergency Preparedness'!$F:$F,$A67)-COUNTIFS('Emergency Preparedness'!$E:$E,Q$3,'Emergency Preparedness'!$F:$F,$A67,'Emergency Preparedness'!$D:$D,NotApplicable)","v":9},16,{"$f":"COUNTIFS('Emergency Preparedness'!$F:$F,$A67,'Emergency Preparedness'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,P$3,'Emergency Preparedness'!$F:$F,$A67)+COUNTIFS('Emergency Preparedness'!$E:$E,Q$3,'Emergency Preparedness'!$F:$F,$A67)","v":16}]
[6.3,"High Consequence Infectious Diseases: Initial Isolation and Management",{"$f":"IFERROR(J68/$P68,\"-\")","v":0},0,0,{"$f":"IFERROR(M68/$Q68,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,J$3,'Emergency Preparedness'!$F:$F,$A68,'Emergency Preparedness'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,J$3,'Emergency Preparedness'!$F:$F,$A68,'Emergency Preparedness'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,J$3,'Emergency Preparedness'!$F:$F,$A68,'Emergency Preparedness'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,M$3,'Emergency Preparedness'!$F:$F,$A68,'Emergency Preparedness'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,M$3,'Emergency Preparedness'!$F:$F,$A68,'Emergency Preparedness'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,M$3,'Emergency Preparedness'!$F:$F,$A68,'Emergency Preparedness'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,P$3,'Emergency Preparedness'!$F:$F,$A68)-COUNTIFS('Emergency Preparedness'!$E:$E,J$3,'Emergency Preparedness'!$F:$F,$A68,'Emergency Preparedness'!$D:$D,NotApplicable)","v":2},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,Q$3,'Emergency Preparedness'!$F:$F,$A68)-COUNTIFS('Emergency Preparedness'!$E:$E,Q$3,'Emergency Preparedness'!$F:$F,$A68,'Emergency Preparedness'!$D:$D,NotApplicable)","v":10},12,{"$f":"COUNTIFS('Emergency Preparedness'!$F:$F,$A68,'Emergency Preparedness'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,P$3,'Emergency Preparedness'!$F:$F,$A68)+COUNTIFS('Emergency Preparedness'!$E:$E,Q$3,'Emergency Preparedness'!$F:$F,$A68)","v":12}]
[6.4,"Surge and Business Continuity Planning",{"$f":"IFERROR(J69/$P69,\"-\")","v":0},0,0,{"$f":"IFERROR(M69/$Q69,\"-\")","v":0},0,0,0,{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,J$3,'Emergency Preparedness'!$F:$F,$A69,'Emergency Preparedness'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,J$3,'Emergency Preparedness'!$F:$F,$A69,'Emergency Preparedness'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,J$3,'Emergency Preparedness'!$F:$F,$A69,'Emergency Preparedness'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,M$3,'Emergency Preparedness'!$F:$F,$A69,'Emergency Preparedness'!$D:$D,NotMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,M$3,'Emergency Preparedness'!$F:$F,$A69,'Emergency Preparedness'!$D:$D,PartiallyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,M$3,'Emergency Preparedness'!$F:$F,$A69,'Emergency Preparedness'!$D:$D,FullyMet)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,P$3,'Emergency Preparedness'!$F:$F,$A69)-COUNTIFS('Emergency Preparedness'!$E:$E,J$3,'Emergency Preparedness'!$F:$F,$A69,'Emergency Preparedness'!$D:$D,NotApplicable)","v":2},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,Q$3,'Emergency Preparedness'!$F:$F,$A69)-COUNTIFS('Emergency Preparedness'!$E:$E,Q$3,'Emergency Preparedness'!$F:$F,$A69,'Emergency Preparedness'!$D:$D,NotApplicable)","v":5},7,{"$f":"COUNTIFS('Emergency Preparedness'!$F:$F,$A69,'Emergency Preparedness'!$D:$D,NotApplicable)","v":0},{"$f":"COUNTIFS('Emergency Preparedness'!$E:$E,P$3,'Emergency Preparedness'!$F:$F,$A69)+COUNTIFS('Emergency Preparedness'!$E:$E,Q$3,'Emergency Preparedness'!$F:$F,$A69)","v":7}]

{"sheet":"Critical Care Services Structur","index":3,"n_rows":145,"n_cols":7,"rows_kept":145,"cut":false,"hidden":false,"merged":[]}
["Section 1","CRITICAL CARE SERVICES: STRUCTURE","Level description","Choose level","Hidden","Hidden","Comments"]
[null,null,null,null,"-"]
[1.1000000000000001,"Levels of Critical Care",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"All patients admitted to a critical care unit must be included in a national clinical audit programme in which Levels of Care data are collected."," met / not met",null,"STANDARDS",{"$f":"$A$3","v":1.1000000000000001}]
[2,"Level of Care classification must not be used in isolation to decide upon a patient's requirements."," met/ not met ",null,"STANDARDS",{"$f":"$A$3","v":1.1000000000000001}]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[null,"None.",null,null,"RECOMMENDATIONS",{"$f":"$A$3","v":1.1000000000000001}]
[null,null,null,null,"-"]
[1.2,"Outcomes",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Critical care units must hold multi-professional clinical governance meetings, including analysis of mortality and morbidity.","met - comprehensive programe with muliprofessional involvement, partially - programme but limited multiprofessional involvement, not met - no review",null,"STANDARDS",{"$f":"$A$12","v":1.2}]
[2,"The unit must participate in a National Audit Programme for Adult Critical Care.","See section 1.1",null,"STANDARDS",1.2]
[3,"Critical care units must participate in a mortality review programme using appropriate methodology to maximise learning and improvements in care.","met / not met ",null,"STANDARDS",1.2]
[4,"Critical care units should participate in a programme of hospital-acquired infection surveillance to monitor and benchmark rates of catheter-related bloodstream infections, antimicrobial use and frequency of multi-resistant infections.eg Infection In Critical Care Quality Improvement Programme ICCQIP","Met / unmet ",null,"STANDARDS",1.2]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"The UK intensive care community should encourage and develop a validated methodology to review referrals to intensive care and evaluate decision making and subsequent outcomes relating to intensive care admission and refusal.","National measure"]
[2,"Units should develop a consistent approach to patient-centred decision-making, evaluating burdens and benefits of admission to intensive care, and be able to demonstrate this through the audit of pre-admission consultation, agreed ceilings of therapy, and time-limited treatment trials.","met - all admissions audited and reviewed, partially met, some audit evidence of this process, not met - no audit information / no review of admissions ",null,"RECOMMENDATIONS",{"$f":"$A$12","v":1.2}]
[3,"Longer-term mortality should be collected on all patients admitted to critical care.","met - collected on all patients, partially met - intermittant audit / review, not met - not reviewed",null,"RECOMMENDATIONS",1.2]
[4,"The UK intensive care community should encourage and develop validated measures of longer-term patient- and family-centred outcomes beyond mortality, including measures of functional ability, socioeconomic consequences, and carer burden.","National measure"]
[5,"The UK intensive care community should encourage and develop validated measures of quality of care relating to end of life and bereavement.","National measure"]
[6,"Critical care units should consider systematic assessment of patient and family experiences and demonstrate how these are used to guide improvement.","met - quarterly assessment, partially met - 1-2 yearly,  not met - not done ",null,"RECOMMENDATIONS",1.2]
[null,null,null,null,"-"]
[1.3,"Level 2 and 3 Physical Facilities",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Critical care facilities must comply with national standards.","met / not met",null,"STANDARDS",{"$f":"$A$28","v":1.3}]
[2,"All new build units must comply with HBN 04-02.","met / not met / not applicable ",null,"STANDARDS",1.3]
[3,"Medicines and fluid storage must comply with HBN 00-03.","met / not met ",null,"STANDARDS",1.3]
[null,null,null,null,"-",1.3]
["RECOMMENDATIONS",null,null,null,"-",1.3]
[1,"Existing units that do not comply should have a timeline to establish when national standards will be met.","met - time line and evidence to suugest progress, partially met - timeline but no evidence of progress, not met - no timeline / not applicable if standards met ",null,"RECOMMENDATIONS",1.3]
[2,"Large units should be divided into smaller units (e.g. 8-10 beds) to facilitate clinical care.","met/not met",null,"RECOMMENDATIONS",1.3]
[3,"The unit should have enough beds and resources to obviate the need to transfer patients to other critical care units for non-clinical reasons.","met = non clinical transfer <0.5% of admissions, partially met < 1%, not met >1% of admissions ",null,"RECOMMENDATIONS",1.3]
[4,"When planning or redeveloping a critical care area, Document HBN 04-02 should be considered.","met, partially met, not met, not applicable",null,"RECOMMENDATIONS",1.3]
[5,"Critical care units should incorporate sufficient storage for medicines (including refrigerated and controlled drugs), IV fluids (including renal replacement) and enteral feeds. Storage areas/rooms should be secure and appropriately temperature controlled for all medicines. ICU designs also, need to account for how selected medicines, including patient's own drugs, will be securely stored and readily accessible near the patient's bedside.","met, partially met, not met, not applicable",null,"RECOMMENDATIONS",1.3]
[6,"It is recommended that critical care areas that have undergone recent new unit planning and building are contacted by those embarking on a new build to share experiences and learning. ","met, partially met, not met, not applicable",null,"RECOMMENDATIONS",1.3]
[7,"Additional factors that should be considered include potential noise and natural light levels, colour and decoration schemes, privacy and dignity needs, and staff and visitor areas. Consideration should also be given to the patient's recovery and rehabilitation needs, including the potential for long-stay patients to spend periods outside.","met, partially met, not met, not applicable",null,"RECOMMENDATIONS",1.3]
[8,"Critical care units should be inspected as part of the peer-review process, including the review of the building and facilities. Feedback should include any concerns or highlight any slippage to timeframes.","met - peer reviewed, feedback included, partially met - peer review, no feedback, not met - no peer review ",null,"RECOMMENDATIONS",1.3]
[9,"Failure to follow HBN 04-02 guidance should be questioned by both Operational Delivery Network and commissioners.","National/regional measure"]
[null,null,null,null,"-"]
[null,null,null,null,"-"]
[1.4,"Clinical Information Systems*",null,null,"-"]
[null,"*If no CIS then Not applicable ",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"The CIS must comply with the set of common specifications, frameworks and implementation guides that support interoperability as specified with the NHS Interoperability Toolkit. (https://digital.nhs.uk/services/interoperability-toolkit).",null,null,"STANDARDS",{"$f":"$A$47","v":1.4}]
[2,"CIS procurements and customisation must involve a multidisciplinary collaboration of all stakeholders who would typically use, maintain and develop the system. This must include input from end users (including representatives of all clinical staff groups), procurement officers, clinical engineering , the CCIO (Chief Clinical Information Officer) and ICT specialists.","met, partially met, not met, not applicable",null,"STANDARDS",1.4]
[3,"The CIS must have a rigorous business continuity access (BCA) plan and resilience system so that critical patient information remains available and system downtime must not compromise patient safety in any way. There must be a process to ensure that sufficient staff trained in BCA contingency measures are available 24/7.","Met = full BCP present and tested, partially = some aspects not expected to continue as usual or BCP untested, Not met = no documented BCP",null,"STANDARDS",1.4]
[4,"Where patient data management systems (PDMS) or electronic patient record (EPR) systems are used, there must be access to a dedicated workstation computer at each bed space. An appropriate number of both mobile and fixed workstations must be available to facilitate timely patient care by medical, nursing and allied staff on ward rounds and on an ad hoc basis.","Met = workstation for every bedspace plus additional workstations for mobile staff, partially met = insufficient mobile workstations, not met = absence of workstation at every bedspace (even if mobile stations available) or absence of any mobile workstations.",null,"STANDARDS",1.4]
[5,"The CIS must have robust implementation and ongoing training programmes to support all staff in its clinical and management use. These should be provided by the NHS organisation in partnership with the vendor company . Due consideration should be given to how this training will be provided to new starters and locum staff. There should be a mechanism by which any specialty involved in the patient's care while on the critical care unit has access to all pertinent information and is able to document in such a way as to facilitate care. This is particularly important when critical care and hospital documentation systems are distinct.","Met = training provided to all staff requiring it including new starters, >90% on first day of clinical duty or before, partially met >80% but <90% trained on first day of starting, not met = <80% trained on day 1",null,"STANDARDS",1.4]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Critical care units should consider using a CIS.","met / not met ",null,"-"]
[2,"CISs should be part of an electronic health record. The specification should include high-resolution data capture from patient monitoring, infusion devices, ventilators, cardiac output measurement, temperature management devices, intra-aortic balloon pumps, extra-corporeal life support (ECLS) devices, blood gas analysers and renal replacement therapy (RRT) devices. A CIS should be capable of customisable display of this information along with clinical notes.","Met = >90% of device types ever used linked to system, partially met = 80-90% of all devices linked, not met = <80% of devices linked (ie we wouldn't expect a unit using 2 IABPs a year to link them, but would expect a unit using them monthly to link them)",null,"RECOMMENDATIONS",{"$f":"$A$47","v":1.4}]
[3,"The CIS should be connected to the hospital's patient information system for demographic and admission/discharge data, to laboratories for results, to radiology for reports and to other key software, e.g. National Critical Care Audit Systems and Hospital Electronic Prescribing and Medication Administration (HEPMA) for electronic data sharing. The CIS should be able to collect and share electronically Critical Care Minimum Data Sets (CCMDS) and national audit data to facilitate electronic generation of reports and audit. In the event of replacing existing CIS, it must be possible to access archived patient records in a user-friendly format.","Met = clinical staff do not need to routinely log in to another system to obtain results required to care for patients, partially met = clinical staff have to log into 1 additional system regularly, not met = staff have to access >1 additional system to obtain routine information required for patient assessment.",null,"RECOMMENDATIONS",1.4]
[4,"Investigation ordering should be fully integrated and recorded, and include electronic prescribing of drugs and fluids and ordering of laboratory and radiology services.","Met = clinical staff do not need to routinely log in to another system to obtain results required to care for patients, partially met = clinical staff have to log into 1 additional system regularly, not met = staff have to access >1 additional system to obtain routine information required for patient assessment.",null,"RECOMMENDATIONS",1.4]
[5,"Daily summary plans should capture electronically activity data from the rest of the CIS, with the addition of free-hand text for healthcare professionals treating and visiting the patients.","Met = captures all required data, Unmet = unable to capture any information regarded as essential to review patient",null,"RECOMMENDATIONS",1.4]
[6,"The CIS should be capable of forming worklists for individual members of the critical care team to allow patient- and staff-based lists of tasks to be completed. The CIS should include the ability to alert when tasks are near due, due and overdue, and record and audit performance.","Met = provides carer-specific worklists and alerts, partially met = either alerts or worklists not provided comprehensively, unmet = unable to provide worklists or does not provide alerts (could probably do with splitting)",null,"RECOMMENDATIONS",1.4]
[7,"There should be a functionality within the database to alert, within a short timeframe, lack of compliance with care bundles and specifically for physiological abnormalities that are undesirable or life threatening. These alerts should be via dashboards displayed clearly within the unit and also via text or email to smartphones or notepad-type devices carried by healthcare staff.","Met = alerts provided in real time in format required by unit, partially met = some alerts but not all those requried or can only be provided in a suboptimal medium, not met = no dashboard facility",null,"RECOMMENDATIONS",1.4]
[8,"The CIS should include customisable transfer/discharge summary, pulling key information from diagnoses, intensive care management, clinical notes, labs and medication.","Met = discharge summary can be created according to specification of unit without duplicate information entry, partially met = discharge summary can be created according to unit spec but requires re-entry of data already in system, not met = disch summary cannot be constructed to satisfactory standard",null,"RECOMMENDATIONS",1.4]
[9,"Flexibility through assessing care records online or through mobile devices should be possible.","Met = can be accessed remotely from any device, partially met = can only be accessed from specific pre configured devices, not met = cannot be accessed or can be accessed but concerns over data security",null,"RECOMMENDATIONS",1.4]
[10,"The CIS should handle authentication and authorisation through Single Sign On, including the use of RFID/smart cards/biometrics.","Met = users can access record by entering a single username/passowrd/smart card at a workstation, partially met = single log in provided computer operating system already logged in, not met = user has to enter ID more than once to access",null,"RECOMMENDATIONS",1.4]
[11,"The system should provide capacity to evolve sophisticated electronic decision support systems, to facilitate patient safety and quality. The CIS should be capable of feeding data to other tele-health solutions for remote monitoring and advice on patient management.","Met = versatile system where users have been able to create decision support algorithms as required, partially met = some pre specified decision support provided but limited additional configuration by end user, Not met = no decision support available",null,"RECOMMENDATIONS",1.4]
[null,null,null,null,"-"]
[1.5,"Clinical Equipment",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"All equipment must conform to the relevant safety standards and must be regularly serviced and maintained in accordance with the manufacturer's guidance. ","met / not met ",null,"STANDARDS",{"$f":"$A$70","v":1.5}]
[2,"Uninterruptable power supply adequate to provide at least one hour of continuity of any critical equipment without battery back-up must be provided.","met / not met ",null,"STANDARDS",1.5]
[3,"There must be a programme in place for the routine replacement of capital equipment.","met / not met ",null,"STANDARDS",1.5]
[4,"All staff must be appropriately trained and  competent and familiar with the use of equipment. Up-to-date training records must be maintained to demonstrate that all staff (medical, nursing, AHP and support staff) have complied with this provision.","met - >85% trained staff for all equipment, partially 75-85% trained staff all equipment, not met < 75% or no clear record.",null,"STANDARDS",1.5]
[5,"There must be an individual designated equipment clinical lead for intensive care whose responsibilities will include the assessment, procurement, use and replacement of equipment on the critical care unit in collaboration with the electro-biomedical engineering (EBME) provider and the organisation's overarching equipment governance framework.","Met / not met ",null,"STANDARDS",1.5]
[6,"EBME support must be available either in-house or on a contracted basis to ensure equipment is appropriately serviced. Regardless of the model of support, EBME personnel must have the appropriate skills and equipment to service the equipment used.","Met / not met ",null,"STANDARDS",1.5]
[7,"Equipment must be uniquely identified and listed on an appropriate asset register along with details of its life cycle and service history/requirements to facilitate planned maintenance and replacement.","met - >85%  equipment, partially 75-85%  all equipment, not met < 75% or no clear record.",null,"STANDARDS",1.5]
[8,"There must be documented procedures for decontamination (cleaning, disinfection and sterilisation as appropriate, depending on equipment risk category and sensitivity of devices). Appropriate sterile services must be provisioned so that national standards are followed for the re-sterilisation of endoscopes and reusable.","met - >85% equipment, partially 75-85% all equipment, not met < 75% or no clear record.",null,"STANDARDS",1.5]
[9,"Critical care units must be have appropriate systems in place to ensure an adequate supply of consumables.","Met = <2 incidents of delay to care or procedure in 12/12, partially met = 2-5 incidents, not met >5 incidents",null,"STANDARDS",1.5]
[10,"There must be robust mechanism for reporting adverse incidents resulting from the use of clinical equipment. Serious incidents involving clinical equipment may also need to be reported to the Medicines and Healthcare Products Regulatory Agency (MHRA).","met - policy in place, partially met, no policy but can evidence, not met, no policy and / or no evidence ",null,"STANDARDS",1.5]
[11,"The MHRA may issue safety alerts pertaining to medical devices, as may device manufacturers from time to time. There must be designated role and robust mechanism for ensuring that such alerts are cascaded to staff and acted upon as appropriate.","met - 100 % alerts received and acted upon, partially met 85-100% received, not met - no robust mechanisms or not able to evidence ",null,"STANDARDS",1.5]
[12,"Sufficient equipment must be available to meet the service demand to enable treatment provision (basic and specialist monitoring, ventilation, renal replacement therapy, information technology facilities etc.) in an appropriate timescale to meet patient need. Consideration must be given to the need to provide additional capacity in times of surge demand.","Met = <2 incidents of delay to care or procedure in 12/12, partially met = 2-5 incidents, not met >5 incidents",null,"STANDARDS",1.5]
[13,"Magnetic resonance imaging (MRI) compatible equipment must be provided for use where mechanically ventilated patients are to undergo MRI investigation. These must be clearly labelled and staff must be adequately trained.","met / not met / not applicable ",null,"STANDARDS",1.5]
[14,"Where advanced monitoring techniques are used (e.g. diagnostic electroencephalography, cardiac output monitors, intracranial pressure/other invasive neuromonitoring), there must be provision of appropriately trained staff to adequately interpret the results in a timely manner and to deal with likely complications of their use where appropriate.","Met = all advanced techniques reported within 6 hours of event (inc verbal and provisional reports), Partially 6-24h, Not met = greater than 24h delay",null,"STANDARDS",1.5]
[15,"Immediate access to point of care blood gas analysis and glucose/ketone analysis on a 24/7 basis must be provided.","Met / not met",null,"STANDARDS",1.5]
[16,"Where equipment is to be trialled on a loan basis for evaluation purposes, it is essential that adequate indemnity and governance arrangements are in place in case of injury to either patients or staff from potentially unfamiliar equipment, and the supplier should provide adequate training to ensure correct use. The EBME provider should facilitate this process by testing the equipment for safety as well as evaluating servicing and maintenance implications.","met / not met",null,"STANDARDS",1.5]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Standardisation of equipment should be encouraged both within the critical care unit and in other areas where intensive care may need to be delivered.","Met = all L3 areas of the hosptial use same monitoring / ventilators / portable ventilators / RRT / monitoring sets.  Partially met = 1 item different, Not met = >1 item different (specialist equipment used in only 1 area not included)",null,"RECOMMENDATIONS",{"$f":"$A$70","v":1.5}]
[2,"The provision of diagnostic ultrasound equipment should be guided by the likely patient population and staff expertise. At very least, there must be immediate access to sufficient ultrasound equipment to ensure that intravascular catheters can be placed safely and in a timely manner, even in emergent circumstances.","met / not met",null,"RECOMMENDATIONS",1.5]
[null,null,null,null,"-"]
[1.6,"Cardiothoracic Critical Care",null,null,"-"]
[null,"*Not applicable to non Cardiothoracic Critical Care",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Consultants, nursing, resident medical, healthcare professional and pharmacy staffing must adhere to the standards outlined in the relevant staffing chapters of GPICS.","met / not met ",null,"STANDARDS",{"$f":"$A$94","v":1.6}]
[2,"Each cardiothoracic critical care unit must have designated lead consultant with training in cardiothoracic intensive care. This should be recognised in their job plan and they should be involved in multidisciplinary service planning and governance within the unit","met / not met ",null,"STANDARDS",1.6]
[3,"Each cardiothoracic critical care unit must have an identified lead nurse who is formally recognised with overall responsibility for the nursing elements of the service.","met / not met ",null,"STANDARDS",1.6]
[4,"There must be a resident doctor or ACCP and a resident cardiac surgeon. There must be on-site 24/7 access to a doctor or ACCP with advanced airway skills. The resident team must be trained in Cardiac Surgery Advanced Life Support (CALS) and be capable of emergency chest re-opening 24/7.","met / not met ",null,"STANDARDS",1.6]
[5,"Postoperative care pathways must be guided by appropriate protocols and delivered by trained personnel in a Level 3 clinical environment that complies with national standards. There should be a clear escalation pathway from post-operative care to intensive care.","met / not met ",null,"STANDARDS",1.6]
[6,"The care of patients falling outside the protocolised care pathways must be reviewed by a multidisciplinary team led by a consultant trained in cardiac Intensive Care Medicine. ","met / not met",null,"STANDARDS",1.6]
[7,"Ventilated patients must have a registered nurse/patient ratio of a minimum 1:1 to deliver direct care. ","met / not met ",null,"STANDARDS",1.6]
[8,"Physiotherapy staffing must be adequate to provide the respiratory management and rehabilitation components of care.",null,null,"STANDARDS",1.6]
[9,"There must be a critical care pharmacist for every cardiothoracic critical care unit, supported by sufficient pharmacy technical staff.","met / not met ",null,"STANDARDS",1.6]
[10,"All cardiothoracic critical care units must participate in local and national audit. For example, for units in England, Wales and Northern Ireland, this is participation in the ICNARC ARCtIC (Assessment of Risk in Cardiothoracic Intensive Care) programme - the national clinical audit for cardiothoracic critical care units. ","met / not met",null,"STANDARDS",1.6]
[11,"Transthoracic and transoesophageal echocardiography must be immediately available. ","met / not met",null,"STANDARDS",1.6]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"The patient monitoring and physical support requirements in a cardiothoracic critical care unit should be no less than the requirements of patients cared for in a general (Level 3) critical care unit.","met / not met ",null,"RECOMMENDATIONS",{"$f":"$A$94","v":1.6}]
[2,"Cardiac and thoracic surgery post-operative care is carried out in a dedicated environment with each component located in close proximity.",null,null,"RECOMMENDATIONS",1.6]
[3,"The cardiothoracic critical care unit should have in place agreed clinical criteria for the appropriate case-mix and arrangements for escalation to a general critical care facility as required.","met = clear written protocol, partially met = occurs in practice but referer/accepter dependent, not met = escalation does not/cannot occur",null,"RECOMMENDATIONS",1.6]
[4,"ACCPs, with adequate training and appropriate support, can provide a safe, sustainable alternative to medical staff in the cardiothoracic critical care unit.","Statement"]
[5,"Each day, a consultant in charge of the cardiothoracic critical care unit should coordinate input from members of the various teams in the immediate post-operative period.","met / not met ",null,"RECOMMENDATIONS",1.6]
[6,"Perfusion services should be readily available.","met / not met ",null,"RECOMMENDATIONS",1.6]
[7,"Cardiothoracic anaesthetists and cardiothoracic surgeons should be integrated into the multidisciplinary nature of each cardiothoracic critical care unit and take an active part in shaping services and analysing quality. Patient mortality audit is currently in the public domain for each unit and each member of the MDT should have an understanding of how their own role contributes to patient outcomes.","met / not met ",null,"RECOMMENDATIONS",1.6]
[null,null,null,null,"-"]
[null,null,null,null,"-"]
[1.7,"Neurocritical Care*",null,null,"-"]
[null,"*NOT Applicable if non neurocritical care",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Consultants, nursing, resident medical, healthcare professional and pharmacy staffing numbers and work patterns must adhere to the same standards outlined in the relevant chapters of GPICS.","Met / not met ",null,"STANDARDS",{"$f":"$A$120","v":1.7}]
[2,"Neurocritical care units should have access to investigation facilities and appropriate clinical expertise for the following: a) diagnostic radiology (24-hour access to CT; access to MRI for ventilated subjects, and diagnostic angiography), b) access to biochemistry and microbiology services to analyse cerebrospinal fluid (CSF), c) neurophysiology (including electroencephalography (EEG) and evoked-response diagnosis and monitoring). Access to continuous 24-hour EEG monitoring is highly desirable.","met - all available, partially - some available ",null,"STANDARDS",1.7]
[3,"All cases requiring immediately lifesaving neurosurgery must be admitted to the local neurosurgical centre irrespective of the initial availability of neurocritical care beds.","fully met - formally agreed and audited pathways in place, partially met - done but not monitored pathway, not met - ",null,"STANDARDS",1.7]
[4,"Patients with a Glasgow Coma Scale (GCS) score of ≤ 8 following a head injury at any time must have access to specialist treatment from neuroscience unit.","met = all patients appropriate for escalation discussed, not met  (must allow local clinicians professional lattitude to NOT refer those clearly too frail for intervetnion) ",null,"STANDARDS",1.7]
[5,"As per NICE QS74, eligible patients must have assessment for in-patient rehabilitation if new cognitive, emotional, behavioural or physical difficulties persist for more than 72 hours.","met / not met",null,"STANDARDS",1.7]
[6,"In addition to general rehabilitation, neurologically impaired patients must have access to specialist neuro-rehabilitation services.","met = have access immediately once ready for discharge from acute centre, partially met = have access but discharge delays >48h for >20% patients, not met = no access or delays > 4 weeks to access neuro rehab",null,"STANDARDS",1.7]
[7,"Neurocritical care must have resources to support mechanical thrombectomy in line with NICE IPG 548.","met - 24/7, partially - 5/7 per week, not met - available less than less. ",null,"STANDARDS",1.7]
[8,"Neurocritical care must have resources to support regional networks for the safe and timely management of patients with subarachnoid haemorrhage. ","met = all patients appropriate for escalation discussed, not met  (must allow local clinicians professional lattitude to NOT refer those clearly too frail for intervetnion) ",null,"STANDARDS",1.7]
[9,"Patients must be cared for by a multi-professional intensive care team with specialist expertise and experience in managing critically ill neurological patients using agreed protocols based on the best evidence available.",null,null,"STANDARDS",1.7]
[10,"Care of critically ill neurological patients must fully integrate involvement of admitting specialties (neurology, neurosurgery, spinal surgery), and diagnostic/interventional specialties (neuroradiology and neurophysiology).",null,null,"STANDARDS",1.7]
[11,"When calculating cerebral perfusion pressure in the management of traumatic brain injury, the arterial transducer should be placed (levelled) at the tragus.",null,null,"STANDARDS",1.7]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Consultants providing out of hours care and advice should have regular timetabled sessions in neurocritical care.","met / not met ",null,"RECOMMENDATIONS",{"$f":"$A$120","v":1.7}]
[2,"Both the patient and family of the patient on neurocritical care should be offered support and guidance in the disease process and longer-term outcomes using specialist nurses and psychologists. ","met = readily available at any point in pathway, partially met = available but not necessarily during critical care stay, not met = no psychology provision",null,"RECOMMENDATIONS",1.7]
[3,"Multimodal monitoring of patients with neurological injury should be consistent with international consensus recommendations.",null,null,"RECOMMENDATIONS",1.7]
[4,"Early and formal involvement of the neurorehabilitation team as part of the multidisciplinary team should be sought to optimise outcomes and facilitate transitions of care.","met = neurorehab consult within first week after injury (may be specialist physio or practitioner or consultant), partially met = neurorehab review prior to transfer, not met = no review in acute setting",null,"RECOMMENDATIONS",1.7]
[5,"Specialist equipment needs to be freely available to facilitate the acute rehabilitative needs of all brain and spinal injured patients while on neurocritical care.",null,null,"RECOMMENDATIONS",1.7]
[6,"Neurocritical care units must be part of a regional network of care, with agreed rational transfer and repatriation protocols that ensure rapid acceptance of patients for specialist care, and transfer back to referring hospitals or onwards for further specialist long-term care when the need for specialist neuroscience care no longer exists.","met - meet full recommendation with audit data , partially - meet recomemendation but no audit data, not met - no networks / poor network ",null,"RECOMMENDATIONS",1.7]
[7,"Follow up and audit of outcomes from neurocritical care should include a measure of functional recovery at a minimum of six months.","met / not met ",null,"RECOMMENDATIONS",1.7]
[8,"Regular neurocritical care morbidity and mortality meetings should be undertaken involving all members of the multidisciplinary team, including the admitting specialties, allowing structured judgement case review.","met = quarterly or more frequent MDT invovlement, partially = less frequent or less MD, not met = no M&M",null,"RECOMMENDATIONS",1.7]
[9,"Patients requiring intensive care for acute neurosurgical and neurological diseases in non-specialist centres should have direct communication to expertise in specialist neuroscience centres.","met/not met",null,"RECOMMENDATIONS",1.7]

{"sheet":"Critical Care Services Workforc","index":4,"n_rows":271,"n_cols":7,"rows_kept":271,"cut":false,"hidden":false,"merged":[]}
["Section 2","CRITICAL CARE SERVICES: WORKFORCE","Level description","Level","Hidden","Hidden","Comments"]
[null,null,null,null,"-"]
[2.1,"Medical Staffing",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Patients’ care must be led by a consultant in Intensive Care Medicine, who is defined as “…. a consultant who is a Fellow/Associate Fellow or eligible to become a Fellow/Associate Fellow of the Faculty of Intensive Care Medicine. A consultant in Intensive Care Medicine will have daytime Direct Clinical Care Programmed Activities in Intensive Care Medicine identified in their job plan. These programmed activities will be exclusively in ICM and the Consultant will not be responsible for a second speciality at the same time.” "," Met = 24/7 cover by consultant in ICM, partially met = all daytimes covered by ICM consultnat but 1-2 nights per week covered by an anaesthetist with direct telephone access to a named \"second on call\" ICM consultant  not met = anything else",null,"STANDARDS",2.1]
[2,"Consultant work patterns must deliver continuity of care.","Met = daytime consutlants work blocks of 3 or more days, with job planned handover time, partially met = blocks of <3 days or days themselves divded but with clear handover, not met = anything else",null,"STANDARDS",2.1]
[3,"The daytime consultant to patient ratio must not normally exceed a range between 1:8 and 1:12.","Fully met = 7 days a week, partially met = 5 days per week",null,"STANDARDS",2.1]
[4,"The daytime intensive care resident to patient ratio should not normally exceed 1:8. ","Fully met = 7 days a week, partially met = 5 days per week",null,"STANDARDS",2.1]
[5,"All staff that contribute to the resident rota must have basic airway skills. All critical care units must have immediate 24/7 on-site access to a doctor or ACCP with advanced airway skills. ","Met / not met ",null,"STANDARDS",2.1]
[6,"There must be a designated Clinical Director and/or Lead Consultant for Intensive Care Medicine.","Met / not met ",null,"STANDARDS",2.1]
[7,"A consultant in Intensive Care Medicine must be immediately available 24/7. The consultant responsible for intensive care out of hours must be able to attend within 30 minutes.","Met / not met ",null,"STANDARDS",2.1]
[8,"A small number of units that remain staffed overnight by an anaesthetic consultant without daytime ICM sessions, by a necessity dictated by the unit’s size and remoteness, must also have a consultant in Intensive Care Medicine available for advice 24/7, either by local agreement or from within the Critical Care Network.","Met / not met ",null,"STANDARDS",2.1]
[9,"A consultant in Intensive Care Medicine must undertake ward rounds twice a day, seven days a week.","Met = >95% of days 2 ward rounds occur, partially met = 90-95%, not met = <90%",null,"STANDARDS",2.1]
[10,"The ward round must have daily input from nursing, microbiology, pharmacy and physiotherapy and regular input from dietetics, speech and language therapy, occupational therapy and clinical psychology to assist decision making.  The nurse in charge should be present in person for the ward round.","Met - all met 7 days per week, partially met - ( define missing groups ) or only 5 days per week, not met - not acheived ",null,"STANDARDS",2.1]
[11,"Rotas for consultants and resident staff must be cognisant of fatigue and the risk of burnout. ","Met = staff confirm rota is resilient, partially met = staff believe rota has features that are unsustainable in the long term, not met = failed rota requiring regular locum cover",null,"STANDARDS",2.1]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"The consultant rota should seek to avoid excessive periods (> 24 hours) of direct patient consultant responsibility. ","met / not met",null,"RECOMMENDATIONS",2.1]
[2,"The resident rota should be compliant with working time directives (i.e. Working Time Directive 2003)","met / not met",null,"RECOMMENDATIONS",2.1]
[null,null,null,null,"-"]
[2.2000000000000002,"Registered Nursing Staff",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Level 3 patients must have a registered nurse/patient ratio of a minimum 1:1 to deliver direct care.","met 98% of the time or not met ",null,"STANDARDS",2.2000000000000002]
[2,"Level 2 patients must have a registered nurse/patient ratio of a minimum of 1:2 to deliver direct care.","met 98% of the time or not met",null,"STANDARDS",2.2000000000000002]
[3,"Each designated critical care unit must have an identified lead nurse who has overall responsibility for the nursing elements of the service e.g. a Band 8a Matron.","met / not met",null,"STANDARDS",2.2000000000000002]
[4,"There must be a supernumerary (i.e. not rostered to deliver direct patient care to a specific patient) senior registered nurse who provides the supervisory clinical coordinator role on duty 24/7 in critical care units. Units with fewer than six beds may consider having a supernumerary clinical coordinator to provide the supervisory role during peak activity periods, e.g. early shifts."," met = supernumerary nurse does not have their own patient >99% of time, partially met = supernumerary nurse is occasionally used in emergency to care for patient on <5% shifts, not met =  supernumerary nurse is required to care for their own patient >5% shifts",null,"STANDARDS",2.2000000000000002]
[5,"Units with greater than ten beds must have additional supernumerary senior registered nursing staff over and above the supervisory clinical coordinator to enable the delivery of safe care (i.e. 11-20 beds +1, 21-30 beds +2, etc.). The number of additional staff per shift will be incremental depending on the size and layout of the unit (e.g. multiple pods/bays, single rooms). Consideration for the need of additional staff also needs to be given during events such as infection outbreak.","Met = unit >11 beds always has second supernumerary nurse avaialble, Partially = available >60% shifts, not met = unit has >11 beds and no additional nurse",null,"STANDARDS",2.2000000000000002]
[6,"Each critical care unit must have a dedicated Clinical Nurse Educator responsible for coordinating the education, training and CPD framework for intensive care nursing staff and pre-registration student allocation. This should equate to a minimum of 1.0 WTE per 75 nursing staff.","met - 1.0 per 75, partially met 1.0 per 100, unmet - no educator or less than 1.0 per 100",null,"STANDARDS",2.2000000000000002]
[7,"All nursing staff appointed to intensive care must be allocated a period of supernumerary practice to enable achievement of basic specialist competence.","Met = always provided until competence achieved, partially = provided but may have own patient before full competencies completed, Not met = anything else",null,"STANDARDS",2.2000000000000002]
[8,"A minimum of 50% of registered nursing staff must be in possession of a post-registration award in Critical Care Nursing.","met or not met",null,"STANDARDS",2.2000000000000002]
[9,"Units must not utilise greater than 20% of registered nurse from bank/agency on any one shift when they are NOT their own staff.","Met = >95% of shifts, partially =90-95% shifts, not <90%",null,"STANDARDS",2.2000000000000002]
[10,"Where direct care is augmented using support staff (including unregistered nursing roles), appropriate training and competence assessment of those staff is required.","met or not met",null,"STANDARDS",2.2000000000000002]
[11,"In addition to leadership competencies the lead nurse/matron (terms are synonymous for this purpose) for the critical care unit must meet, as a minimum, the same specialist critical care nurse educational standards as the staff caring for Level 3 patients.","met or not met",null,"STANDARDS",2.2000000000000002]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Step 1 of National Competencies for Adult Critical Care Nurses should commence when a nurse with no previous experience of the specialty begins working in Intensive Care Medicine.","met / not met ",null,"RECOMMENDATIONS",2.2000000000000002]
[2,"Steps 2 and 3 of National Competencies for Adult Critical Care Nurses should be incorporated into academic intensive care programmes.","met / not met ",null,"RECOMMENDATIONS",2.2000000000000002]
[3,"Post-registration adult intensive care nursing courses should be awarded a minimum of 60 credits at Level 6. To meet the requisite standard, courses must adopt the core curriculum described in the National Standards for Critical Care Nurse Education (2016).","National measure"]
[4,"Additional Clinical Nurse Educators will be required for larger units, i.e. 1.0 WTE for approximately 75 staff. Clinical Nurse Educators should be senior intensive care nurses who have attained Step 3 competence, have completed a post-registration intensive care award and be in possession of a post-registration teaching qualification. ","See above",null,"RECOMMENDATIONS",2.2000000000000002]
[5,"Registered nurses supplied through an agency to work in intensive care should provide evidence of appropriate experience and competence to care for critically ill patients.","met / not met ",null,"RECOMMENDATIONS",2.2000000000000002]
[6,"The Best Practice Principles to Apply When Considering Moving Critical Care Nursing Staff to a Different and Unfamiliar Clinical Care Area should be followed at all times to enable staff to achieve and maintain competence in intensive care nursing. The potential adverse effects on staff morale, recruitment and retention should be considered, particularly when this is recurrent. Executive Directors of Nursing should take requisite steps to minimise this.","met - policy in place, partially met - no policy but followed, not met - no policy and not followed",null,"RECOMMENDATIONS",2.2000000000000002]
[7,"Supernumerary clinical coordinators should have completed Step 4 competencies in addition to their post-registration award in intensive care nursing.","met / not met ",null,"RECOMMENDATIONS",2.2000000000000002]
[null,null,null,null,"-"]
[2.2999999999999998,"Workforce, Induction & Training of Medical and Nursing Staff",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Each critical care unit must have a dedicated supernumerary Clinical Nurse Educator (1 WTE per approximately 75 staff), responsible for coordinating the education and training and CPD framework for intensive care nursing staff and pre-registration students.","See above 2.2.6 ",null,"STANDARDS",2.2999999999999998]
[2,"All nursing staff appointed to intensive care must be allocated a period of supernumerary practice to allow adequate time for registered nurses to develop basic skills and competencies assessed to ensure they can safely care for a critically ill patient.","See above 2.2.7",null,"STANDARDS",2.2999999999999998]
[3,"All registered nurses commencing in intensive care must be working towards Step 1 of the National Competency Framework for Adult Nurses in Critical Care.","See above 2.2.1- recommendation",null,"STANDARDS",2.2999999999999998]
[4,"A minimum of 50% of registered nursing staff must be in possession of a post-registration award in intensive care nursing."," See above 2.2.8",null,"STANDARDS",2.2999999999999998]
[5,"Where direct care is augmented using non-registered support staff, appropriate training and competence assessment must be provided.","See above 2.2.11",null,"STANDARDS",2.2999999999999998]
[6,"All non-consultant medical staff commencing a post in the critical care unit must have a consultant-led departmental induction to the unit with a formal published programme. This must take place prior to commencing any clinical duties, and must include, but is not limited to: a) Instructions on how to raise patient safety concerns, b) Instructions on how to raise issues of bullying and undermining, c) Introduction to key members of medical, nursing, allied professional and operational support staff, d) Highlighting key departmental guidelines and how to access all departmental guidelines, e) Explanation and distribution of the doctor’s rostered work pattern, and their roles and responsibilities when rostered to work both during the daytime and out of hours, f) Arrangements for access to all IT systems, including passwords, provision of identification badges and tutorials on the use of any clinical IT systems on the day of induction, and g) Assigning each doctor an Educational Supervisor.","met - inlcudes all elements, partially met - some elements, not met - no identifiable written programme.",null,"STANDARDS",2.2999999999999998]
[7,"There must be a regular (e.g. weekly), consultant-led teaching programme relevant to all non-consultant grade doctors. Time to attend this must be protected, with attendance mandatory for all non-consultant grade doctors rostered to be on duty. These sessions should be open to all members of the MDT.","met - meets all elements, partially met - some elements met, not met - no regular teaching ",null,"STANDARDS",2.2999999999999998]
[8,"There must be regular clinical governance, morbidity and mortality, and literature review meetings open to all members of the MDT. These meetings must be attended by both consultants and non-consultant grade doctors and non-consultant grade doctors must have the opportunity to lead the presentations at these sessions.","met - meets all elements, partially met - some elements met, not met - no meetings as described",null,"STANDARDS",2.2999999999999998]
[9,"All consultants responsible for the educational supervision of trainees must be recognised by the GMC for this role and there must be a sufficient time allocated in the Educational Supervisor’s job plan to allow 0.25 SPA per trainee.","met - 0.25 PA per trainee, partially met less than 0.25 per trainee, not met, no time allocated. ",null,"STANDARDS",2.2999999999999998]
[10,"All non-consultant grade doctors must have a bespoke personal development plan relevant to their developmental needs, and the doctor must be given the time and opportunity to achieve the objectives within the personal development plan as agreed with their Educational Supervisor.","met / not met",null,"STANDARDS",2.2999999999999998]
[11,"All staff supplied through an agency to work in intensive care must provide evidence of appropriate experience and competence to care for critically ill patients.","met / not met / not applicable ( if never using agency) ",null,"STANDARDS",2.2999999999999998]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Clinical Nurse Educators should be in possession of a post-registration award in intensive care and an appropriate postgraduate certificate in education or equivalent.","met / not met ",null,"RECOMMENDATIONS",2.2999999999999998]
[2,"Nurse education programmes should follow the National Standards for Critical Care Education (2016) and include both clinical competence and assessment.","met / not met ",null,"RECOMMENDATIONS",2.2999999999999998]
[3,"Study leave should be provided for all members of the MDT for intensive care-related courses and conferences.","Met = funded/partially funded (may be from charitable sources) study leave up to 10 days per year available to all staff, Partially = study leave available but unfunded or <4 days per year, Not met = anything else",null,"RECOMMENDATIONS",2.2999999999999998]
[4,"A creative learning environment should be provided for all staff offering a range of learning experiences to meet the defined learning outcomes for their continuing professional development.",null,null,"RECOMMENDATIONS",2.2999999999999998]
[5,"There should be a regular monthly forum chaired by a senior member of the department, where all members of the MDT can feed back any patient safety, educational or operational issues to the senior medical, nursing and management team.","Met = montly forum for full MDT, partially met = some provision but not monthly or not formalised, Not met = no mechanism",null,"RECOMMENDATIONS",2.2999999999999998]
[6,"The hospital and/or departmental library should provide access to relevant and up-to-date Intensive Care Medicine journals and books relevant to nursing, medical and AHP staff.","Met = trust provides electornic access to appropriate ICM journals and resources, partially met = some access but clinicians believe notable omissions, Not met = no access",null,"RECOMMENDATIONS",2.2999999999999998]
[7,"The critical care unit should provide access to online clinical resources from within the clinical area for all clinical staff.","Met = trust provides electornic access to appropriate ICM journals and resources, partially met = some access but clinicians believe notable omissions, Not met = no access",null,"RECOMMENDATIONS",2.2999999999999998]
[8,"All consultants should provide regular teaching and feedback to non-consultant grade doctors, nursing staff and allied health professionals.",null,null,"RECOMMENDATIONS",2.2999999999999998]
[9,"There should be a regular multidisciplinary educational programme, including simulation involving medical, nursing and allied health professional staff.","Met = fully evidence simulation and MDT education programme, Partial = some MDT teaching provided but not comprehensive",null,"RECOMMENDATIONS",2.2999999999999998]
[10,"Step 4 leadership competencies (or equivalent) (CC3N, 2018) should be completed by all senior nurses who undertake the role of shift leader (including those who lead partial teams in larger units) and those aspiring to such a role.","See above 2.2.5 recommendation ",null,"RECOMMENDATIONS",2.2999999999999998]
[11,"Specialist step competencies (CC3N, 2018) should be completed whenever relevant to the case-mix of the unit. For example, nurses working in critical care units in major trauma centres should complete the major trauma step competencies.","met = >50% staff complete, partially 25-50%, not <50%",null,"RECOMMENDATIONS",2.2999999999999998]
[null,null,null,null,"-"]
[2.4,"Advanced Critical Care Practitioners",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"ACCPs must act within the formal code of conduct of their present statutory regulator. Trainee ACCPs are required to practice within the structure of the FICM curriculum, with the appropriate level of supervision.","Met/ not met",null,"STANDARDS",2.4]
[2,"All ACCPs / ACPs working on Critical Care should have completed non medical prescribing ","Met = >95%, Partially = 75-95%, Not = <75%",null,"STANDARDS",2.4]
[3,"ACCPs must acknowledge any limitations in their knowledge and skills and should not perform clinical activities they do not feel skilled or competent to perform. As part of their training and ongoing professional development, they must develop (and continue to develop) a high level of clinical judgment and decision making.",null,null,"STANDARDS",2.4]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"A FICM-associated ACCP with supervision from an ICM consultant falls within the definition of an intensive care resident and may provide the onsite 24/7 immediate clinical/medical cover for patients.","Statement"]
[2,"An ACCP who entered a training post after 5 November 2017 should successfully complete an ACCP specific two-year Postgraduate Diploma (PgDip) which meticulously follows the FICM ACCP curriculum, and register with FICM as a trainee ACCP.  ACCPs who entered training pre the above date should ensure their training programme adheres to the requirements of the FICM ACCP Membership criteria. ","Met / not met / not applicable (if no ACCP)",null,"RECOMMENDATIONS",2.4]
[3,"After successful completion of clinical and academic PgDip ACCP requirements, including Non- Medical Prescribing, ACCPs should apply to the FICM for ACCP Membership.","Met = all ACCPs have FICM, partially met, = at least 50% have FICM not met = <50%",null,"RECOMMENDATIONS",2.4]
[4,"It is recommended that employing units should only appoint FICM-associated ACCPs to ensure a standard knowledge base, minimum skillset and that FICM ACCP curriculum competencies have been met.","Met = all ACCPs have FICM competencies partially met > 50% have FICM competencies, not met = <50%",null,"RECOMMENDATIONS",2.4]
[5,"While working autonomously, the ACCP will always work within a multi-professional team led by a consultant who is trained in ICM.",null,null,"RECOMMENDATIONS",2.4]
[6,"It is recommended that critical care units employing ACCPs have transparent ACCP standard operating procedures and outcomes, and that any incidents are reviewed as part of the unit’s governance arrangements.","Met = SOP in place, not met = no SOP",null,"RECOMMENDATIONS",2.4]
[7,"It is recommended that line management of ACCPs forms a tripartite arrangement between an ICM consultant, ICU clinical supervisor and professional lead such as a senior nurse or AHP from the ACCP’s base profession.","Met/not met",null,"RECOMMENDATIONS",2.4]
[8,"Continuing professional development (CPD/appraisal) for ACCPs should be undertaken according to the FICM CPD/appraisal guidance on an annual basis.","met/not met",null,"RECOMMENDATIONS",2.4]
[null,null,null,null,"-"]
[null,null,null,null,"-"]
[2.5,"Pharmacists",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"STANDARDS",2.5]
[1,"There must be a designated intensive care pharmacist for every critical care unit.","met / not met",null,"STANDARDS",2.5]
[2,"There should be 0.1 whole time equivalent (WTE) pharmacist for every Level 3 bed and 2 for every Level 2 bed for a 5/7 a week service.","met = 0.1/bed, partially = 0.05-0.1 per bed, not <0.05",null,"STANDARDS",2.5]
[3,"Clinical pharmacy services should be available seven days per week. However, as a minimum, the service must be provided five days per week (Monday-Friday) with plans to extend the ward service to seven days a week before 2020.","met -7 days per week, partially met 5 days per week. ",null,"STANDARDS",2.5]
[4,"The most senior pharmacist within a healthcare organisation who works on a daily basis with critically ill patients must be competent to at least Advanced Stage II (excellence level) in adult critical care pharmacy.","met / not met ",null,"STANDARDS",2.5]
[5,"Other clinical pharmacists who provide a service to intensive care areas and have the minimum competencies to allow them to do so (Advanced Stage I) must have access to an Advanced Stage II (excellence-level) intensive care pharmacist for advice and referrals.","met / not met ",null,"STANDARDS",2.5]
[6,"As a minimum, the pharmacist must attend daily multidisciplinary ward rounds on weekdays (excluding public holidays). Attend =  dips into ward round(s)  as appropriate and discusses issues","met - 5 days per week, partially met - 3-5 days per week, not met - less than less or not on ward round.",null,"STANDARDS",2.5]
[7,"There must be sufficient patient-facing pharmacy technical staff to provide supporting roles.","met / un met ",null,"STANDARDS",2.5]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"To maintain the continuity of the service during annual leave, sick leave and training leave, additional appropriate resources will be required (20% minimum is recommended).","Met = service continues as usual during annual leave, Partially = some cover but not normal service, Not met = no cover or on call type cover only",null,"RECOMMENDATIONS",2.5]
[2,"Intensive care pharmacists should undergo an independent, recognised process to verify competence level.","met / not met ",null,"RECOMMENDATIONS",2.5]
[3,"Senior specialist intensive care pharmacist support should, preferably, be provided within the organisation but may be provided from a critical care network or on a regional basis.","met / not met / not applicable ",null,"RECOMMENDATIONS",2.5]
[4,"A peer-to-peer practitioner visit should occur at least once a year to ensure training issues are identified and to help maintain the competence of small teams and sole workers. This supports General Pharmaceutical Council (GPhC) revalidation.","met -yearly, partially met 1-3 yearly, not met - not done or > 3 yearly ",null,"RECOMMENDATIONS",2.5]
[5,"Where a team of intensive care pharmacists is in place, there should be a structured range of expertise, from trainee to Fellow level.","met / not met ",null,"RECOMMENDATIONS",2.5]
[6,"Intensive care pharmacists are encouraged to become active independent prescribers.","Statement"]
[null,null,null,null,"-"]
["2.6","Physiotherapists",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Physiotherapists must participate in opportunities for integrated decision making and dissemination of clinical information. This may include handovers, consultant-led multidisciplinary ward rounds, MDT meetings, team briefings or operational and patient safety briefings.","met / not met",null,"STANDARDS",2.6]
[2,"The critical care MDT must have an identifiable lead physiotherapist who will be accountable for clinical service delivery, provide training and mentorship to junior staff, and oversee clinical governance and quality assurance.","met / not met ",null,"STANDARDS",2.6]
[3,"All physiotherapy staff must receive appropriate competency-based training to ensure delivery of high-quality physiotherapy intervention within critical care. This training must include staff who are not critical care specialists but are involved in out of hours/on-call cover.","met / not met ",null,"STANDARDS",2.6]
[4,"Physiotherapy staffing must be adequate to provide the respiratory management and rehabilitation components of care, ensuring compliance with both clinical and professional guidelines and standards.","met - fully meet standard 7 days per week , partially met - meet standard 5 day per week, not met ",null,"STANDARDS",2.6]
[5,"Respiratory physiotherapy must be available to critical care patients 24 hours a day and seven days a week. This includes the provision of an out of hours/on-call service which may utilise specialist and non-specialist intensive care staff.","met / not met ",null,"STANDARDS",2.6]
[6,"Physiotherapists, as part of the multidisciplinary team, must ensure the completion of a comprehensive clinical assessment of those at risk of or with identified physical and non-physical morbidity within four days of admission to intensive care and before discharge from intensive care. This should include the collaborative setting of individualised, patient-centred rehabilitation goals.","met - 85% patients, partially met 75-85% of patients, not met <75% of patients or no audit data",null,"STANDARDS",2.6]
[7,"Patients receiving rehabilitation must be offered therapy by the multidisciplinary team across a seven-day week, and of a quantity and frequency appropriate to each therapy in order to meet the clinical need and rehabilitation plan for an individual patient. Rehabilitation plans should be updated accordingly.  ","met - 7 days per week, partially met 5 days per week, ",null,"STANDARDS",2.6]
[8,"Physiotherapists must ensure a formal handover of care to the relevant ongoing physiotherapy team(s) following discharge from intensive care. This should include the holistic individualised structured rehabilitation plan.","met - 85% patients, partially met 75-85% of patients, not met <75% of patients or no audit data",null,"STANDARDS",2.6]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"The service provision should be based upon the overall patient case-mix taking into account acuity, dependency and complexity of the clinical case-mix. Staff resources and capability should be appropriately matched both in knowledge, skills, and number to deliver comprehensive respiratory care and holistic rehabilitation. However, further work is recommended of paramount importance exploring demand-capacity models to robustly determine physiotherapy staffing ratios in intensive care.The suggested ratio would be one WTE physiotherapist to four ICU Level 3 beds","met 1 WTE to four level 3 beds ( or equivalent level 2 ), partially met 0.5-1.0 WTE per four level 3 beds, not met < 0.5 per four level 3 beds ",null,"RECOMMENDATIONS",2.6]
[2,"Physiotherapy services should provide assessment and intervention for physical rehabilitation seven days per week.","met 7 days per week, partially met 5 days per week, not met < 5 days per week ",null,"RECOMMENDATIONS",2.6]
[3,"The value and role of Therapy Support Workers or Rehabilitation Assistants should be considered as part of either the intensive care physiotherapy or multidisciplinary workforce.","Statement"]
[4,"Competency/capability frameworks should be in place encompassing all Agenda for Change (AfC) bands applicable to the local service. This should reflect relevant national competency and professional development frameworks. A local training and development programme should exist to align with these frameworks.","met / not met ",null,"RECOMMENDATIONS",2.6]
[5,"Clear role specifications should exist for intensive care physiotherapists who have reached the level of Advanced Practice according to the Health Education England Framework.","met / not met ",null,"RECOMMENDATIONS",2.6]
[6,"The intensive care physiotherapy service should have a clear local operational policy and core standards for service provision which reflects both national guidance and standards and local variations.","met / not met ",null,"RECOMMENDATIONS",2.6]
[7,"The intensive care physiotherapy service or, where appropriate, as part of the MDT, should have robust and evidence-based clinical guidelines/standard operating procedures surrounding airway clearance interventions and specialist rehabilitation interventions including early mobilisation of patients in intensive care.","met / not met ",null,"RECOMMENDATIONS",2.6]
["8","The lead physiotherapist, or appropriate deputy, should participate in all relevant local (and where appropriate, regional) intensive care operational delivery, governance and quality improvement groups. This may include governance meetings, service improvement work-streams, morbidity and mortality review meetings, business continuity meetings, operational or clinical management meetings. This should also include active participation/collaboration with their regional Critical Care Operational Delivery Network.","met / not met ",null,"RECOMMENDATIONS",2.6]
[9,"The physiotherapy intervention(s), as part of the patient’s individualised, structured rehabilitation plan, should be matched to the acuity, dependency and complexity of the patient, considering the patient’s clinical needs and tolerance to intervention. This should align with the individualised, patient-centred rehabilitation goals and a holistic rehabilitation approach should be taken across a 24-hour period. ","met / not met ",null,"RECOMMENDATIONS",2.6]
[10,"Physiotherapists should play a key collaborative role in the coordination and delivery of ventilation and tracheostomy weaning plans, including post-extubation and post-decannulation care. Additionally, physiotherapists should be a core part of the multidisciplinary delivery of non-invasive ventilation in intensive care.","met / not met ",null,"RECOMMENDATIONS",2.6]
[11,"Targeted airway clearance interventions should only be considered in selected patients when clinically indicated. Routine secretion clearance therapy for all invasively-ventilated patients is not recommended.","met / not met ",null,"RECOMMENDATIONS",2.6]
["12","Where a local intensive care follow-up clinic/services exists, a physiotherapist should contribute to this service. ","met / not met ",null,"RECOMMENDATIONS",2.6]
[null,null,null,null,"-"]
[2.7,"Dietetics",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Critical care units must have access to dietitian five days a week during working hours","met / not met ",null,"STANDARDS",2.7]
[2,"There must be a dietitian as part of the critical care multidisciplinary team. If the critical care dietitian is working alone, they must be at the level of advanced practice. Where more than one dietitian is required, there must be an identifiable lead dietitian of advanced clinical practice level 4 to ensure an appropriate range of expertise within the team and to have overall responsibility for the service provision.","met = dedicated named dietician(s) / not met ",null,"STANDARDS",2.7]
[3,"Intensive care dietitian(s) must have satisfied local or national competency requirements and be able to undertake a nutrition assessment and implement an appropriate nutrition support plan for critically ill patients. If working at advanced clinical practice level, dietitians must be able to demonstrate application of the documented capabilities outlined in the multi-professional framework for advanced clinical practice in England.","met / not met ",null,"STANDARDS",2.7]
[4,"Intensive care dietitian(s) must work collaboratively contributing to consultant-led ward rounds, MDT meetings, and have regular consultant communication where nutritional goals, risks and plans are discussed as per the NICE CG83.","met / not met ",null,"STANDARDS",2.7]
[5,"Intensive care dietitian(s) must lead on the development and implementation of any local nutrition support guideline(s).","met / not met ",null,"STANDARDS",2.7]
[6,"Intensive care dietitian(s) must contribute to appropriate strategic meetings and clinical governance activities, including leading regular nutrition-related audits and acting on the results, plus undertaking quality improvement projects that demonstrate the impact of dietetics on service delivery, quality and effectiveness.","met / not met ",null,"STANDARDS",2.7]
[7,"Intensive care dietitian(s) must provide ongoing education and training for other healthcare professionals.","Met = comprehensive nutrition teaching programme for other staff, Partially = evidence of ad hoc teaching by dietician, Not met = no dietician led teaching",null,"STANDARDS",2.7]
[8,"Intensive care dietitian(s) must provide a structured handover to a ward dietitian when patients are discharged from the critical care unit, considering nutrition-related morbidity as per the NICE Quality Standard.","Met = >75% patients, Partially 50-75%, Not <50%",null,"STANDARDS",2.7]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"There is a staffing level of at least 0.05-0.1 WTE per critical care bed to provide the dietetics service is recommended. ","Met = >0.05, Partially = 0.025-0.05, Not <0.025",null,"RECOMMENDATIONS",2.7]
[2,"Intensive care dietitian(s) provide extended scope practitioner roles such as inserting feeding tubes, using indirect calorimetry to determine energy expenditure and supplementary prescribing where appropriate.","Met = all listed, Partially = some, Not = none",null,"RECOMMENDATIONS",2.7]
[3,"Intensive care dietitian(s) should consider undertaking and disseminating nutrition-related research to widen the evidence base.","Statement"]
[4,"Intensive care dietitian(s) should consider joining national (Critical Care Specialist Group of the British Dietetic Association) and international intensive care and nutrition-specific societies (Intensive Care Society, European Society for Intensive Care Medicine, European Society for Parenteral and Enteral Nutrition, etc.).","met / not met",null,"RECOMMENDATIONS",2.7]
[5,"Intensive care dietitian(s) should represent dietetics on national and international society committees and guideline development groups.","Statement"]
[6,"Intensive care dietitian(s) working at an advanced level should have or be working towards a master’s level award.","Statement"]
[null,null,null,null,"-"]
[null,null,null,null,"-"]
[2.8,"Speech and Language Therapists",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Critical care units must have access to a speech and language therapist five days a week during working hours.","met = 5 days, partially =>3 days, not <3 days",null,"STANDARDS",2.8]
[2,"All patients with a tracheostomy must have communication and swallowing impairment assessed by a Speech and Language Therapist.","Met = >98%, partially met > 80% ",null,"STANDARDS",2.8]
[3,"All critically ill patients who have communication and/or swallowing difficulties (dysphagia) must have timely access to an SLT service.","met > 90% of referals seen within 24 hours (excluding weekend), partially met 75-90% seen within 24 hours, not met < 75% seen within 24 hours ",null,"STANDARDS",2.8]
[4,"All Speech and Language Therapists working in intensive care must be appropriately trained, competent and familiar with the use of relevant equipment.","met / not met ",null,"STANDARDS",2.8]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"The critical care SLT service is provided by a minimum of 0.1 WTE (whole time equivalent) per bed ","met = 0.1, partially 0.05-0.1, not <0.05",null,"RECOMMENDATIONS",2.8]
[2,"Patients should have access to a communication aid according to individual need in order to facilitate patient interaction and rehabilitation.","met = always available inc advanced devices, partially = available but may not have same day access or simple devices only, not met = no access (apart from simple white boards/paper)",null,"RECOMMENDATIONS",2.8]
[3,"Speech and Language Therapists should contribute to a suitable tracheostomy or non-invasive ventilation weaning plan for complex or long-stay patients.","met / not met ",null,"RECOMMENDATIONS",2.8]
[4,"SLT are available seven days a week.","met 7 days per week, partially met 5 days per week, not met, less than 5 days or sporadic service",null,"RECOMMENDATIONS",2.8]
[5,"FEES should be available for Speech and Language Therapists to use in assessment and management of dysphagia in intensive care patients.","met - FEES available 5 days/week, partialy met - adhoc availability, not met - no service ",null,"RECOMMENDATIONS",2.8]
[6,"Speech and Language Therapists should work as an integral member of the multidisciplinary team on the critical care unit, contributing to all multidisciplinary ward rounds, tracheostomy teams, clinical governance groups, audit, research, education and policy development.","met - SLT attend daily ward rounds 5 days a week, partially met - available on request, not met = no service   ",null,"RECOMMENDATIONS",2.8]
[7,"Swallowing and communication recommendations and treatment plans should be included in any medical handover when the patient is transferred from intensive care to another unit or ward.","Met (included in standardised handeover process) or not met ",null,"RECOMMENDATIONS",2.8]
[8,"Patients who are being considered for ‘risk feeding’ should have access to an SLT assessment in order to clarify their level of aspiration risk and optimum oral feeding consistencies.","met > 90% of referals seen within 24 hours (excluding weekend), partially met 75-90% seen within 24 hours, not met < 75% seen within 24 hours ",null,"RECOMMENDATIONS",2.8]
[null,null,null,null,"-"]
[2.9,"Occupational Therapists",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Critical care units must have access to occupational therapy services 5 days a week during working hours.","met = 5 day a week access, partially met = < 5 days/week, not met = no service or on call service from other depts only",null,"STANDARDS",2.9]
[2,"Patients receiving rehabilitation must be offered therapy by the multidisciplinary team, across a seven-day week, and of a quantity and frequency appropriate to each therapy in order to meet the clinical need and rehabilitation plan for an individual patient; rehabilitation plans should be updated accordingly.","See 2.6.7",null,"STANDARDS",2.9]
[3,"All occupational therapy staff working in a critical care environment must adhere to the Royal College of Occupational Therapists’ Code of Ethics and Professional Conduct (COT 2015) and the Professional Standards for Occupational Therapy Practice (COT 2017).","met / not met ",null,"STANDARDS",2.9]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"There should be an identifiable lead occupational therapist with appropriate experience, who will be accountable for service provision and development.","met / not  met",null,"RECOMMENDATIONS",2.9]
[2,"The occupational therapy clinical lead should be responsible for supporting learning opportunities, training and clinical supervision for junior staff providing occupational therapy services in intensive care.","met / not  met",null,"RECOMMENDATIONS",2.9]
[3,"The critical care team should include a senior occupational therapist with sufficient experience to contribute to and develop rehabilitation programmes that address the complex functional, cognitive and psychosocial needs of the patient cohort.","met / not  met",null,"RECOMMENDATIONS",2.9]
[4,"Occupational therapy staff on the critical care unit should be able to assess and provide non-pharmacological treatment for those patients who present with delirium.","met (OT involved in management of delirium in ICU) partially = involved but no routine review of patients with delirium or not met ",null,"RECOMMENDATIONS",2.9]
[5,"Occupational therapists should be involved in intensive care follow-up clinics to assess and facilitate appropriate referrals rehabilitation or specialist services and to address any long-term physical and non-physical impairment affecting occupational performance.","met /not met",null,"RECOMMENDATIONS",2.9]
[null,null,null,null,"-"]
[null,null,null,null,"-"]
["2.10","Psychologists",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"All patients must be screened daily for delirium using a validated instrument.","met = > 95% screened, partially met > 80%, not met - < 80% or no audit data",null,"STANDARDS",2.101]
[2,"Non-pharmacological strategies must be in place to prevent and reduce delirium.","met - there is a local delirium guideline detailing non pharmalogical stratergies. Not met",null,"STANDARDS",2.101]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Psychologists should ensure that delirium is accurately assessed by nurses using a validated instrument, and that when delirium is detected, risk factors are reviewed and corrected by the MDT.  They should advise on non-pharmacological strategies to prevent and reduce delirium at the ward level (by improving the environment) and patient level (to facilitate orientation and engagement).","met / not met",null,"RECOMMENDATIONS",2.101]
[2,"Psychologists should ensure that patients and relatives receive psychological education to explain the psychological impact of intensive care drugs, procedures and environment. This can be delivered in person or via information leaflets.","met / not met",null,"RECOMMENDATIONS",2.101]
[3,"NICE CG83 and QS158 stipulate that patients should receive assessments and interventions for psychological as well as physical problems throughout the intensive care pathway. These should be delivered or supervised by qualified psychologists.","met = triggered or routine assessment available for all patients, partially = only available at certain points in pathway (ICU/ward/follow up), Not met = not available at all",null,"RECOMMENDATIONS",2.101]
[4,"Psychologists should organise short psychological assessments for all awake, alert patients in intensive care6 using a validated measure such as the Intensive Care Psychological Assessment Tool.","met = >75% suitable patients assessed, partially 50-75%,not <50% (or no audit data)",null,"RECOMMENDATIONS",2.101]
[5,"If a patient is screened as being at risk of future psychological morbidity, psychological support should be offered by psychologists or other appropriately trained staff (e.g. nurses or psychology trainees) to give patients the opportunity to express their needs and feelings, and to have those feelings validated and normalised.","met/not met",null,"RECOMMENDATIONS",2.101]
[6,"All patients found to be at risk of psychological morbidity (following the short assessment) should receive a comprehensive assessment before discharge from critical care. Psychologists should ensure that psychological needs, support and goals are included in the individualised structured rehabilitation programme that is formally documented and handed over at the time of transfer to general wards.","met = 75% assesseed before discharge, partially met = 50-75% or assessed after discharge from ICU, not met = not assessed",null,"RECOMMENDATIONS",2.101]
[7,"The psychologist should advocate (in conjunction with hospital outreach and mental health teams) for a system to be in place for at-risk intensive care patients to receive psychological support on general wards.","met/not met",null,"RECOMMENDATIONS",2.101]
[8,"Psychologists should contribute to the information (verbal and written) patients and relatives receive to help them continue their personal rehabilitation plans and to know who to contact if they need support after leaving hospital.","met/not met",null,"RECOMMENDATIONS",2.101]
[9,"Psychologists should participate in the follow-up reviews that intensive care patients receive in the community or at outpatient clinics.","met = always available at FU clinic, partially = available by referral, not met = not avaialble",null,"RECOMMENDATIONS",2.101]
[10,"As part of the critical care unit MDT, the psychologist should provide: a) Training for staff to increase knowledge and understanding of psychological reactions, delirium, environmental stressors and psychological outcomes of critical illness, b) Consultation with the multidisciplinary team on communication, sleep, effects of sedation, anxiety, stress, mood, delirium, family issues and holistic care plans, c) Psychological support for families. Relatives may need support to cope with the shock of a family member becoming critically ill and being admitted to the critical care unit, as well as stress and exhaustion from caring for a patient during a long-term admission. They may also need bereavement support if their family member dies in the critical care unit. ","Met = all elements, partially = some, not = none (could be split)",null,"RECOMMENDATIONS",2.101]
[11,"During patients’ rehabilitation and recovery period, the psychologist should provide: a) Consultation with outreach and general ward staff regarding psychological support for intensive care patients, b) Tailored evidence-based interventions for persisting morbidity such as anxiety, depression or PTSD; these should be offered by psychologists in a well-resourced follow-up service and should include trauma-focused cognitive behavioural therapy, c) Where funding for this is not available, referrals of patients directly to psychological therapy services, or recommendations for GPs to make referrals to these services, or advice to patients on how to access local psychosocial services, and d) Drop-in support groups for intensive care patients and their families after discharge from hospital, held in the hospital or community.","Met = all elements, partially = some, not = none (could be split)",null,"RECOMMENDATIONS",2.101]
[12,"Employers have a duty of care to support staff working in a stressful environment such as intensive care, where burnout is highly prevalent. Workplace stress should be addressed at organisational, team and individual levels. Psychologists should consult with intensive care leadership on systemic issues influencing staff well-being. Additionally, psychologists should run or oversee staff support programmes including one-to-one sessions, drop-in groups or reflective rounds according to staff wishes and availability, as well as coaching sessions for senior managers.","Met = routinely available, partially = some ad hoc staff support, not = no staff support",null,"RECOMMENDATIONS",2.101]
[13,"To develop this coordinated service for patients, families, and staff, critical care units should employ a senior HCPC-registered practitioner psychologist. Large critical care units should have access to a WTE, and smaller units should have access to a psychologist with dedicated time for intensive care to deliver the points above.","met/not met",null,"RECOMMENDATIONS",2.101]
[null,null,null,null,"-"]
[2.11,"Healthcare Scientists Specialising in Critical Care",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Critical Care Scientists must comply with the professional standards of behaviour and practice set out in Good Scientific Practice (GSP).","met/not met",null,"STANDARDS",2.11]
[2,"Critical Care Scientists responsible for management of medical devices and point of care diagnostic services must comply with the standards set by the Medicines and Healthcare Products Regulatory Agency (MHRA) and the International Organisation for Standardisation (ISO) standard (22870:2016). ","met/not met",null,"STANDARDS",2.11]
[3,"Critical Care Scientists voluntarily registered with the Health and Care Professions Council (HCPC) must meet the Standard of Proficiency and comply with the Standards of Conduct, Performance and Ethics.","met = are registered and comply / not met",null,"STANDARDS",2.11]
[4,"Critical care units receiving trainee healthcare scientists for training in intensive care must comply with the requirements for training set for them by the National School of Healthcare Scientist (NSHCS).","met / not met",null,"STANDARDS",2.11]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"The Critical Care Scientists should successfully complete an approved training programme, either via accredited specialist training or as part of the Scientist Training Program (STP) commissioned by the National School of Healthcare Science (NSHCS) and should be registered with the HCPC.","met/not met",null,"RECOMMENDATIONS",2.11]
[2,"The Critical Care Scientists should work collaboratively to be a dynamic member of the multidisciplinary team, assisting in the provision of high quality, patient-centred care within the critical care environment.","met = embedded in dept, partially = available but not embedded, not",null,"RECOMMENDATIONS",2.11]
[3,"The Critical Care Scientists should draw on specialist knowledge to provide advice to medical, nursing and wider multidisciplinary team working in a critical care setting about the safe and effective use of medical devices used within the critical care environment, including monitoring, diagnostic and therapeutic technologies supporting critically ill patients.","met / not met",null,"RECOMMENDATIONS",2.11]
[4,"The Critical Care Scientists should develop and support research activities, including facilitating evidence based practice and Implementation of the latest technologies and software to the critical care environment.","met / not met",null,"RECOMMENDATIONS",2.11]
[5,"The Critical Care Scientists should provide effective management and support for medical devices, including advising on optimal clinical settings and troubleshooting, resulting in focused, efficient and high-quality care.","met = evidence eg logs or equipment testing available / partially = happens but no evidence, not met",null,"RECOMMENDATIONS",2.11]
[6,"The Critical Care Scientists should contribute to the educational needs of the multidisciplinary team, including delivering training, mentorship and educational support.","met = evidence of involvement in teaching and training / not met",null,"RECOMMENDATIONS",2.11]
[7,"The Critical Care Scientists should demonstrate flexibility and adaptability to work across diverse pathways of patient care and clinical services that are both routine and highly specialised.","Statement"]
[8,"The Critical Care Scientists should work safely and effectively within their scope of practice and ensure they do not practise in areas where they are not proficient.","met/not met",null,"RECOMMENDATIONS",2.11]
[9,"As part of the multidisciplinary team, the Critical Care Scientists should contribute to the strategic direction, planning and delivery of critical care services.","met (ideally evidence eg attend dept meetings)/ not met",null,"RECOMMENDATIONS",2.11]
[10,"The Critical Care Scientists should engage with the Society of Critical Care Technologies (SCCT) as their professional body in order to work in collaboration with the Academy for Healthcare Science and the NSHCS.","met/not met",null,"RECOMMENDATIONS",2.11]
[null,null,null,null,"-"]
[2.12,"Support Staff",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"All support staff must have clearly identifiable roles with specific competencies.","met / not met ",null,"STANDARDS",2.12]
[2,"All support staff must have a period of induction and supernumerary status.","met / not met",null,"STANDARDS",2.12]
[3,"All support staff must be appropriately trained, competent and familiar with the use of equipment.","met / not met",null,"STANDARDS",2.12]
[4,"All support staff must be included within the intensive care team and be updated on key unit issues and developments.","met / not met",null,"STANDARDS",2.12]
[5,"Support staff roles must be clearly identifiable to colleagues, patients and visitors to the department, either by uniform and/or name badges.","met / not met",null,"STANDARDS",2.12]
[6,"Intensive care areas must develop healthcare support worker roles to assist registered nurses in delivering direct patient care and in maintaining patient safety.","met / not met",null,"STANDARDS",2.12]
[7,"Healthcare support workers must complete the Care Certificate and adhere to the Code of Conduct for healthcare support workers.","met / not met",null,"STANDARDS",2.12]
[8,"Administrative roles must be developed to ensure all clinical staff are free to give direct patient care, and supported with essential data collection.","met / not met",null,"STANDARDS",2.12]
[9,"Each intensive care area must have sufficient staff responsible for the cleanliness of the environment.","met / not met",null,"STANDARDS",2.12]
[10,"Where direct care is augmented using support staff (including unregistered nurses), appropriate training and competence assessment of those staff are required.","met / not met",null,"STANDARDS",2.12]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"All staff should be encouraged to attend further training and/or education to support their development.","met / not met ",null,"RECOMMENDATIONS",2.12]
[2,"Each critical care area should have healthcare support workers 24/7 to assist nursing staff in delivery of direct patient care.","met = all shifts covered, partially = 75% covered, not <75%",null,"RECOMMENDATIONS",2.12]
[3,"Each critical care area should have ward clerk/receptionist cover seven days per week.","met = 7/7, partially 5/7, not = no receptionist",null,"RECOMMENDATIONS",2.12]
[4,"Each critical care area should have a dedicated housekeeper/cleaner seven days per week.","met = 7/7, partially 5/7, not = no dedicated staff",null,"RECOMMENDATIONS",2.12]
[5,"Each critical care area should have a data clerk or dedicated time allotted to a suitable member of staff for data entry to a nationally recognised audit programme (such as ICNARC or SICSAG) and responsibility for the validation of these data. The Intensive Care National Audit and Research Centre (ICNARC) ‘advise that a unit with approximately 600 admissions a year need one full-time member of staff (or equivalent) to keep up with the demands of validation within the prescribed timescales for active participation'.","met = full cover wiht leave cover, partially = less than recommended cover or no leave cover, not met = no dedicated cover",null,"RECOMMENDATIONS",2.12]
[null,null,null,null,"-"]
[2.13,"Smaller Remote and Rural Critical Care Units","Only relevent for small number of units. An autopopulate feature of not applicable would be useful",null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Network support must be in place to ensure smaller, remote and rural critical units meet these standards and recommendations.","met = active participation in network / not met",null,"STANDARDS",2.13]
[2,"The critical care service must be led by consultants trained in Intensive Care Medicine (ICM).","met / not met",null,"STANDARDS",2.13]
[3,"There must be access to appropriate advice from a consultant in ICM at all times.","met = 24/7 access to advice / not met",null,"STANDARDS",2.13]
[4,"Dedicated daytime critical care must be provided by a consultant trained in ICM with no other commitments. ","met = 7/7, partially = 5/7 (or involves covering other areas at same time)",null,"STANDARDS",2.13]
[5,"There must be a doctor or ACCP with advanced airway skills resident within the hospital 24/7.","met / not met",null,"STANDARDS",2.13]
[6,"There must be a 24/7 dedicated resident on the critical care unit.","met / not met",null,"STANDARDS",2.13]
[7,"There must be structured handover between day-time and night-time staff supported by standardised policies for practice.","met / not met",null,"STANDARDS",2.13]
[8,"Appropriate CPD must be supported by the employer and undertaken by all professionals who deliver intensive care.","met / not met",null,"STANDARDS",2.13]
[9,"Regional transport arrangements (road and air) must be put in place to allow timely, safe transfer of patients with an appropriate level of monitoring, staffing and skills.","met / not met",null,"STANDARDS",2.13]
[10,"All critical care units, including Level 2 units, must enter data into national databases such as ICNARC or SICSAG.","met / not met",null,"STANDARDS",2.13]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Network support should be explicit, resourced and supported by all the Healthcare Organisations, Boards, networks and regions involved, and recognised in job planning.","met / not met",null,"RECOMMENDATIONS",2.13]
[2,"Units should consider the development of telemedicine techniques for clinical decision making and educational support, in conjunction with their regional network.","Statement"]
[3,"Remote critical care units should implement appropriate joint clinical governance procedures with both networked units and transfer services to include case-based review, critical incident analysis, and joint educational sessions.","met = formal arrangements with SLA in place / not met",null,"RECOMMENDATIONS",2.13]
[4,"Where an intensive care pharmacist or healthcare professional, such as a physiotherapist or dietician, cannot be effectively delivered locally in a small unit, advice should be accessible from specialist colleagues through network support. Appropriate training bodies should devise and support remote and rural training posts in critical care.","met = formal arrangements with SLA in place / not met",null,"RECOMMENDATIONS",2.13]

{"sheet":"Critical Care Services Process","index":5,"n_rows":279,"n_cols":7,"rows_kept":279,"cut":false,"hidden":false,"merged":[]}
["Section 3","CRITICAL CARE SERVICES: PROCESS","Level description","Level","Hidden","Hidden","Comments"]
[null,null,null,null,"-"]
[3.1,"Admission, Discharge and Handover",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"The decision to admit to the critical care unit and the management plan must be discussed with the duty consultant in Intensive Care Medicine."," Met = >95%, partial = >90%, not <90% or not data",null,"STANDARDS",3.1]
[2,"There must be documentation in the patient record of the time and decision to admit to critical care.","< 85% met, 75-85 partially met, < 75% or no data not met",null,"STANDARDS",3.1]
[3,"Unplanned admissions to the critical care unit must occur within four hours of making the decision to admit."," Met = >95%, partial = >90%, not <90% or no data",null,"STANDARDS",3.1]
[4,"Patients must have a clear and documented treatment escalation plan.","Met >95%, partial 80-95%, not <80 or no audit evidence",null,"STANDARDS",3.1]
[5,"Patients must be reviewed, in person, by a consultant in Intensive Care Medicine as urgently as the clinical state dictates and always within 12 hours of admission to critical care.","95% of the time - Met, <95% or no data - not met",null,"STANDARDS",3.1]
[6,"Transfer to other critical care units for non-clinical reasons must be avoided where possible.","met = non clinical transfer <0.5% of admissions, partially met < 1%, not met >1% of admissions ",null,"STANDARDS",3.1]
["7a","Consultant in Intensive Care Medicine-led ward rounds must occur twice a day (including weekends and national holidays).  ","< 85% met, 75-85 partially met, < 75% or no data not met",null,"STANDARDS",3.1]
["7b","The nurse in charge should be present in person for the ward round.","< 85% met, 75-85 partially met, < 75% or no data not met"]
[8,"Patients discharged from critical care must have access to an intensive care follow-up programme.","met / not met",null,"STANDARDS",3.1]
[9,"Discharge from critical care to a general ward must occur within four hours of the decision and must occur between 07:00hrs and 21:59hrs."," met = >80%, partially = 60-80%, not <60%",null,"STANDARDS",3.1]
[10,"There must be a standardised handover procedure for medical, nursing and AHP staff for patients discharged from critical care units with a formalised transfer process. This must include their structured rehabilitation prescription.","met / not met",null,"STANDARDS",3.1]
["11","Patients undergoing specialist care must be repatriated to a healthcare organisation closer to their home when clinically appropriate to continue their rehabilitation, and this must occur within 48 hours of the decision to repatriate.","< 85% met, 75-85 partially met, < 75% or no data not met",null,"STANDARDS",3.1]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[null,"None",null,null,"RECOMMENDATIONS",3.1]
[null,null,null,null,"-"]
[3.2,"Capacity Management",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Hospital management teams must optimise the use of critical care capacity at all times. The admission and discharge of critical care patients must be prioritised, such that patients requiring critical care support are admitted without delay (within four hours after decision to admit and completion of essential resuscitation/imaging) and patients no longer requiring critical care are discharged within four hours.",">90% admitted within 4 hours, 85-90% admitted within 4 hours, < 85% admitted within 4 hours or not data\n",null,"STANDARDS",3.2]
[2,"The final decision on utilisation of critical care beds and staff (which includes moving staff to help in other areas of the hospital at times of need) rests jointly with the duty consultant and the duty nurse in charge of the critical care unit. Under no circumstances should clinical decisions be over-ridden by non-clinical operational management teams. ","met / not met",null,"STANDARDS",3.2]
[3,"Critical care units must have documented escalation plans suitable for their hospital facilities and must audit and review the usage of these plans.","met / not met",null,"STANDARDS",3.2]
[4,"Hospital boards must demonstrate regular oversight of the use of critical care escalation and the provision of intensive care outside of the critical care unit.","met / not met",null,"STANDARDS",3.2]
[5,"Escalation plans must balance risks of non-clinical transfer against risk of care outside of the critical care unit.","met / not met",null,"STANDARDS",3.2]
[6,"Escalation plans must differentiate between escalation during ‘normal’ operation and escalation during major incidents or pandemic scenarios.","met / not met",null,"STANDARDS",3.2]
[7,"Regional Intensive Care Networks must have escalation plans documented and agreed at medical director and chief executive level to allow the duty intensive care consultants and duty nurses in charge to coordinate the usage of intensive care beds across the network.","met / not met / not applicable",null,"STANDARDS",3.2]
[8,"Regional pandemic escalation plans must include trigger levels for agreed critical care admission criteria and thresholds for restriction of planned activity to assist neighbouring critical care units","met / not met / not applicable",null,"STANDARDS",3.2]
[9,"Regional Intensive Care Networks must have an agreed policy on escalation of care and repatriation between secondary and tertiary units to include escalation and, if required, prioritisation of transfers over local elective activity.","met / not met / not applicable",null,"STANDARDS",3.2]
[10,"Regional Intensive Care Networks must ensure that a system to record capacity across the network is in use, and that this is updated regularly.","met / not met / not applicable",null,"STANDARDS",3.2]
[11,"Transfer to other critical care units for non-clinical reasons must be avoided where possible.","Met = non clinical transfer <0.5% of admissions, partially met < 1%, not met >1% of admissions ",null,"STANDARDS",3.2]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
["1","Critical care units should determine the emergency capacity they require to meet Standard 1 locally, based on their admission and occupancy data.  The capacity to cope with the predicted emergency workload can then be managed by ensuring an appropriate number of beds available for emergency admissions before accepting elective admissions.","met / not met",null,"RECOMMENDATIONS",3.2]
[2,"Acute hospitals will require at least one critical care bed per 35 acute hospital beds; hospitals undertaking a large amount of complex major surgical procedures are likely to need significantly more than this.","met = 1:35 or greater, partially 1:45-1:35",null,"RECOMMENDATIONS",3.2]
[3,"Training should be provided to nursing staff in areas used for critical care escalation.","met = comprehensive documented training plan in place, partially = some training but not comprehensive",null,"RECOMMENDATIONS",3.2]
[4,"When using alternative areas of the hospital to provide critical care capacity, there should be adequate senior nursing and medical input such that the standards of care provided to those patients meet the standards provided to the patients within the critical care unit.","met = immediate access to ICU resident / registrar /nurse in charge for advice + twice daily consultant ward round",null,"RECOMMENDATIONS",3.2]
[5,"Decisions to proceed with major elective surgery should take into account current occupancy, provision of emergency capacity over the next 24 hours and, at times of regional network escalation, the emergency capacity in neighbouring units.","met / not met",null,"RECOMMENDATIONS",3.2]
[6,"Critical care units may find it useful to develop a statistical model locally that provides predictable data on the number of emergency admissions they should plan to accommodate in each 24-hour period, and use this model to assist decision making on when it is safe to proceed with planned elective work.","Statement"]
[null,null,null,null,"-"]
[3.3,"Critical Care Outreach and Rapid Response Systems",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"There must be a hospital wide, standardised approach to the detection of the deteriorating patient and a clearly documented escalation process.","met / not met",null,"STANDARDS",3.3]
[2,"All hospitals must use a validated track and trigger early warning score system that allows rapid detection of the signs of early clinical deterioration in all non-pregnant adult patients over 16 years. The National Early Warning Score (NEWS-2) is the recommended for call  systems as the more efficient and effective. Using a common score ensures that staff operate the same language across the patient pathway and enhances the benefits of an early warning system. As part of a multi-trigger system, other triggers such as urine output/ acute kidney injury alerts, cause for concern and patient/carer Call for Concern, should be considered as they will enhance the recognition of the deteriorating patient.","met / not met",null,"STANDARDS",3.3]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Each hospital should have a graded clinical response strategy consisting of three levels: low, medium and high. Each level of response should detail what is required from staff in terms of observational frequency, skills and competence, interventional therapies and senior clinical involvement. It should define the speed and urgency of response, including a clear escalation policy to ensure that an appropriate response always occurs and is available 24/7.","met / not met",null,"RECOMMENDATIONS",3.3]
[2,"Each organisation should ensure patients receive care from appropriately trained critical care outreach, rapid response or equivalent teams. The critical care outreach (CCO)/Rapid Response staff should have annual competency-based assessment of core and additional specific competencies from a local or regional programme. This should relate to first line clinical assessment and intervention, be clearly outlined and closely reflect the Department of Health (DH) competencies for the recognition and response to the acutely ill patients in hospital.","met 24/7, partially met daytime only or 5 days per week, not met - less than this frequency",null,"RECOMMENDATIONS",3.3]
[3,"There should be accessible educational support for registered and non-registered ward staff in caring for the acutely ill ward patient in line with recorder and first responder level as outlined in the DH competencies for the recognition and response to the acutely ill patients in hospital5. Staff looking after Level 1 and enhanced care area patients should be trained following the National Competency Framework for Level 1 and Enhanced Care Areas.","met / not met",null,"RECOMMENDATIONS",3.3]
[4,"Organisations should aim to deliver Comprehensive Critical Care Outreach as outlined by the seven core elements and have an operational policy that defines the remit of the CCO/Rapid Response or equivalent team within the organisation, in regard to these seven core elements.","met 24/7, partially met daytime only or 5 days per week, not met - less than this frequency",null,"RECOMMENDATIONS",3.3]
[5,"All patients should be reviewed by the CCO team (or equivalent) following discharge from the critical care unit to the ward."," Met - < 85%, partialy met 85-75%, unmet > 75% or no data",null,"RECOMMENDATIONS",3.3]
["6a","All CCO teams should participate in the National Critical Care Outreach Activity Outcome Dataset. ","met / not met",null,"RECOMMENDATIONS",3.3]
["6b","Each organisation should develop audit tools to assess utilisation of their track and trigger and graded response system with clear governance procedures for action of poor compliance healthcare organisation-wide. This should be undertaken in combination with an audit of compliance against the standards within NICE CG502 and must be fed back to healthcare organisation Boards and Critical Care Networks where relevant.","met / not met"]
["7a","Each hospital should be able to provide a CCO/rapid response team, or equivalent, that is available 24 hours per day, seven days a week. ","met / not met",null,"RECOMMENDATIONS",3.3]
["7b","There should be regular review of service provision to facilitate proactive approaches in order to match service configuration against local demands and activity.  These should be reflected in the operational policy. There should be a nominated lead of service at healthcare organisation Board level with appropriate communication cascade.","met / not met"]
[null,null,null,null,"-"]
[null,null,null,null,"-"]
[3.4,"Infection Control",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
["1","Staff must follow safe insertion and maintenance procedures for intravascular and urinary catheters, and remove them when not required to minimise the risk of infection.","met = policy and training in place with daily care bundle checklist and audit data, partially = no formal daily checklist or no audit, not met = no policy",null,"STANDARDS",3.4]
[2,"Infection control procedures must be documented and agreed by the multi-professional team.","met - policy in place not met - no policy",null,"STANDARDS",3.4]
[3,"The WHO Five Moments of Hand Hygiene must be observed. Hand contamination is often due to contact with the environment rather than directly with the patient.","Handwashing audit - Met - < 95%, partilly met 95-85%, unmet > 85%",null,"STANDARDS",3.4]
[4,"Cleaning of the environment must be undertaken by trained staff and subject to audit and quality control, with particular attention to high-contact surfaces. Duties of cleaning and nursing staff, in cleaning specific surfaces, should be clearly defined.","met = policy in place with regular audit data and systematic reports, partially = policies in place but only ad hoc audits, not met = anything else",null,"STANDARDS",3.4]
[5,"There must be surveillance systems in place for audit and feedback of nosocomial infection, reporting to the national scheme where applicable, for example, reporting central venous catheter-related bloodstream infection to the Public Health England Infection in Critical Care Quality Improvement Programme ICCQIP).","met - supply data to ICCQIP ( or equivalent) , partially met - locally monitored, not met - not regularly monitored",null,"STANDARDS",3.4]
[6,"The principles of antibiotic stewardship must be adhered to in consultation with the microbiology team.","Met = documented daily consultant microbiologist input at least 6/7 OR audit data against trust stewardship programme >85% compliance, partially = <85% (some units exempt from audits because of daily micro consult hence all decisions automatically vetted by microbiologist)",null,"STANDARDS",3.4]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Patients should be screened for carriage of MRSA and/or carbapenemase-producing organisms according to locally determined prioritisation. Sensitivity of risk factor algorithms is generally low and universal screening is preferable in highly endemic regions.","met - done > 95% of the time , partially met 85-95% of the time, unmet - <85% or no data or not done",null,"RECOMMENDATIONS",3.4]
[2,"Patients with MRSA carriage or infection should receive topical suppression to reduce shedding and, if possible, single-room isolation.","met / unmet ",null,"RECOMMENDATIONS",3.4]
[3,"Patients with diarrhoea and airborne infections should take precedence over others in allocation of single-room isolation. Patients with suspected or confirmed influenza should be placed in single rooms appropriate for respiratory isolation.","met / not met ",null,"RECOMMENDATIONS",3.4]
[4,"Design of new units should include infection control specialists as part of the planning team. In particular, the bed spacing, proportion of single rooms and provision of sinks should be considered according to patient case-mix, national guidelines and prevalence of multi-resistant infections.","met / not met / not applicable",null,"RECOMMENDATIONS",3.4]
[5,"The intensive care team should have access to an infection control and prevention team led by a microbiologist who can offer timely review and advice. Ideally, this should be part of timetabled microbiology rounds during the week. The microbiologist will advise on the choice and duration of antimicrobial chemotherapy in accordance with local formularies as a part of antibiotic stewardship.","met / not met",null,"RECOMMENDATIONS",3.4]
[6,"Infection control nursing staff or intensive care nurses with infection control training should be available to provide day-to-day advice on prevention of spread of infection, isolation priority and procedures and decontamination. Allocation of patients to single-room isolation for known or suspected infection should be reviewed on admission and frequently thereafter.","met / not met ",null,"RECOMMENDATIONS",3.4]
[7,"There should be a means of continuous improvement in infection prevention and control, for example using surveillance and feedback.","met = formal audit and review process in plance / unmet",null,"RECOMMENDATIONS",3.4]
[null,null,null,null,"-"]
[3.5,"Interaction with Other Services: Microbiology, Pathology, Liaison Psychiatry and Radiology.",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"There must be daily input from microbiology.","Met = 7/7 , partially, 5/7 plus on call, unmet if less",null,"STANDARDS",3.5]
[2,"There must be local antimicrobial prescribing guidelines in accordance with the principles of antimicrobial stewardship.","met / not met",null,"STANDARDS",3.5]
[3,"Clear protocols must be in place for management of massive haemorrhage including the role of laboratory services.","met / not met",null,"STANDARDS",3.5]
[4,"Acutely ill patients must have access to diagnostic radiology services at all times including timely access to a radiologist.","met / not met",null,"STANDARDS",3.5]
[5,"All imaging investigations must be reported within an agreed timeframe relevant to the investigation by someone appropriately trained. All imaging investigations need to be accompanied by a formal, permanently recorded report covering the entirety of the investigation.","met / not met",null,"STANDARDS",3.5]
[6,"There must be seven-day availability of radiology services, appropriate to the specialties being cared for, to allow timely investigation of critically ill patients. This would include, for example, ultrasound and CT-scanning to aid sepsis diagnosis and source control; and in neurocritical care units, access to interventional neuroradiology.","met = full service 7/7, partially = 7/7 service but some elements not always available (eg 7/7 reporting but interventional service only daytimes), unmet = <7/7 service",null,"STANDARDS",3.5]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Microbiology advice should be from an adequately senior clinician, and onsite, face-to-face interaction is encouraged.","Met / not met",null,"RECOMMENDATIONS",3.5]
[2,"Critical or unexpected results of clinical pathology, microbiology or radiological investigations should be actively communicated to a responsible clinician according to local fail-safe policies.","policy in place = met, no policy = not met",null,"RECOMMENDATIONS",3.5]
[3,"Urgent clinical chemistry and haematology advice should be available within 60 minutes from an appropriate specialist and a radiologist should be immediately contactable to support the management of acutely ill patients at all times.","met / not met",null,"RECOMMENDATIONS",3.5]
[4,"All point of care laboratory devices used to assist clinical decision making should be subject to appropriate quality assurance mechanisms, agreed by laboratory and end users.","met = fully centralised lab standard QA process in place with audit evidence, partially = some QA process with intermittent audit, unmet = no laboratory standard QA process",null,"RECOMMENDATIONS",3.5]
[5,"Clear protocols for access to radiology services that are not available on site (e.g. interventional radiology, MRI in ventilated patients) should be available.","met / not met",null,"RECOMMENDATIONS",3.5]
[6,"Liaison psychiatry services should be available in all acute hospitals with a single point of referral. Emergency mental health referrals should be seen within one hour of referral and urgent mental healthcare referrals within 24 hours of referral (within the liaison team’s usual operating hours).","met = available and meets time criteria, partially = available but not <1h <24h, not met = not available",null,"RECOMMENDATIONS",3.5]
[7,"Patients who have self-harmed, irrespective of the apparent motivation, should have a comprehensive psychosocial assessment. This should generally be the responsibility of the liaison psychiatry service and should not be delayed until after medical treatment is complete unless life-saving treatment is necessary, or the patient is unconscious or otherwise incapable of being assessed.","met / not met",null,"RECOMMENDATIONS",3.5]
[8,"Liaison professionals should be available to advise on issues around mental capacity and there should be working arrangements detailing who is responsible for assessing patients who may need to be detained under mental health legislation.","met / not met",null,"RECOMMENDATIONS",3.5]
[null,null,null,null,"-"]
[null,null,null,null,"-"]
[3.6,"Rehabilitation",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"The rehabilitation needs of all patients must be assessed within four days of admission to intensive care (or on discharge if sooner) and a rehabilitation plan outlined by all relevant therapy professions as clinically indicated.","> 85% of patients - met , 75-85% partially met, < 75% ( or no data ) unmet ",null,"STANDARDS",3.6]
[2,"Patients receiving rehabilitation must be offered therapy by the multi-professional team across a seven-day week and of a quantity and frequency appropriate to each therapy, in order to meet the clinical need and rehabilitation plan for an individual patient. Rehabilitation plans should be updated accordingly.","all rehab needs met 7 days a week = met, all rehab needs met 5 days per week = partially met, rehab needs not met consistently = unmet",null,"STANDARDS",3.6]
[3,"All patients must be screened for delirium at least daily, and when changes or fluctuations in behaviour occur; in the event of a positive delirium screen, family should be informed, strategies to facilitate patient orientation implemented and medical review of risk factors completed.","> 85% of patients - met , 75-85% partially met, < 75% ( or no data ) unmet ",null,"STANDARDS",3.6]
[4,"All patients with a tracheostomy must have communication and swallowing impairment assessed by a Speech and Language Therapist.","> 85% of patients - met , 75-85% partially met, < 75% ( or no data ) unmet ",null,"STANDARDS",3.6]
[5,"Patients who stay in critical care for more than four days and are at risk of morbidity must have their ongoing rehabilitation needs addressed at post discharge follow-up, or in the community setting, at two to three months after discharge from critical care. At this point, additional referrals to any necessary services can be made.","> 85% of patients - met , 75-85% partially met, < 75% ( or no data ) unmet ",null,"STANDARDS",3.6]
[6,"Adults at risk of poor quality recovery must have an individualised rehabilitation plan documented in their formal handover of care when transferred from critical care to a general ward. All members of the care team must be aware of this. Patient involvement in setting this rehabilitation plan should occur as soon as feasible and appropriate."," > 85% of patients - met , 75-85% partially met, < 75% ( or no data ) unmet ",null,"STANDARDS",3.6]
[7,"Adults who were in critical care and at risk of poor quality recovery must be given information to explain what they can do to help their recovery. This information should be provided, at the latest, before discharge from hospital.","> 85% of patients - met , 75-85% partially met, < 75% ( or no data ) unmet ",null,"STANDARDS",3.6]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Physiotherapy services should provide assessment and intervention for both acute respiratory and physical rehabilitation seven days per week; provision should be made for other therapy services to be provided as needed at weekends."," met 7 days a week = met,  met 5 days per week = partially met,  not met consistently = unmet",null,"RECOMMENDATIONS",3.6]
[2,"Specialist rehabilitation co-ordinator roles should be considered to facilitate the oversight of the rehabilitation pathway for patients, and to ensure that assessments, referrals and documentation are completed and transferred to ongoing services and teams.","met = rehab coordinator (eg senior nurse); partially met = has other roles, unmet = doens't exist",null,"RECOMMENDATIONS",3.6]
[3,"The role of therapy support workers or rehabilitation assistants should be considered as part of the rehabilitation team; these roles may be uni-professional or multi-professional in nature and recruited from nursing or allied health backgrounds.  These may enable enhanced delivery and increased efficiency of rehabilitation service delivery, as well as ongoing rehabilitation to be delivered following discharge from critical care. Further work is required to determine the appropriate grading of these roles.","Statement"]
[4,"Rehabilitation outcomes should be monitored and progression made using outcome measures appropriate for the stage of recovery, individual therapy, and dependent on local resources (including personnel, equipment, and finance).","met = rehab progression monitoring assessments in place inc after leaving ICU (eg CPAT), partially = on icu only, unmet = no progression monitoring",null,"RECOMMENDATIONS",3.6]
[5,"The rehabilitation plan that forms part of the handover of care on discharge from critical care should address all relevant domains for individual patients including, but not restricted to, physical, functional, communication, social, spiritual, nutritional and psychological.","met /  not met ",null,"RECOMMENDATIONS",3.6]
[6,"To facilitate the rehabilitation component of the formal handover of care on discharge from critical care to a general ward, weekly multidisciplinary rehabilitation ward rounds should be led by a senior member of the critical care multi-professional team and result in an update to the rehabilitation goals.  These should be set in conjunction with the patient and/or carer where appropriate.","met /  not met ",null,"RECOMMENDATIONS",3.6]
[7,"Expectations of both patients and families should be identified regularly and addressed in a consistent manner by the most appropriate senior member of the team; all patient and family communication should be centrally documented to ensure that it can be accessed easily by all team members.","met /  not met ",null,"RECOMMENDATIONS",3.6]
[8,"For high-risk/complex patients, capturing the experience for the patient and family in a manner that they can reflect upon and engage with during the time spent in hospital should be considered. This may take the form of diaries, either paper or electronic, and may include photos, videos and written information. This material may be collected prospectively or retrospectively depending on the desire of patient and family. ","met / not met ",null,"RECOMMENDATIONS",3.6]
[null,null,null,null,"-"]
[null,null,null,null,"-"]
[3.7,"Intensive Care Follow Up",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Patients with higher risk of morbidity related to critical illness must be given information about ongoing rehabilitation goals in the community.","met = all patients provided with rehab goals, partially = selected patients, unmet = none",null,"STANDARDS",3.7]
[2,"Patients discharged from the critical care unit must have access to an intensive care follow-up programme. which can include review of clinical notes, patient questionnaires to assess recovery and an outpatient clinic appointment two to three months’ post hospital discharge if required for specific patients.  ","met / not met",null,"STANDARDS",3.7]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"The follow-up programme should be formally and clearly communicated to the patient and their relatives on discharge from critical care, and again on discharge from hospital. Primary care should also be informed through the discharge summary.","met = all patients, partially = selected patients, unmet = none",null,"RECOMMENDATIONS",3.7]
[2,"The follow-up programme should ensure the delivery of structured and supported self-directed rehabilitation to all patients at critical care discharge and at hospital discharge.","met = all patients, partially = selected patients, unmet = none",null,"RECOMMENDATIONS",3.7]
[3,"A minimum 20-30 minute follow-up appointment should be offered two to three months after hospital discharge if appropriate. The follow-up team should include an intensive care consultant, intensive care nurse, clinical psychologist, physiotherapist, dietician and occupational therapist according to the individual patient’s needs.","met = all appropriate patients, partially = selected patients limited by capacity not need, unmet = none",null,"RECOMMENDATIONS",3.7]
[4,"Selection of patients for follow up should be based on length of stay (more than three days) or at increased risk (e.g. following anaphylaxis, or post-partum intensive care). Self-selection of patients should also be facilitated.","met / not met",null,"RECOMMENDATIONS",3.7]
[5,"Follow up should involve actively seeking common physical sequelae, such as weakness, weight loss and sexual dysfunction, and the consequences of critical care unit-related procedures (e.g. tracheostomy).","met / not met",null,"RECOMMENDATIONS",3.7]
[6,"Review of current medication should be performed and rationalised with input from pharmacy if required.","met / not met",null,"RECOMMENDATIONS",3.7]
[7,"Psychological sequelae (such as anxiety, depression, nightmares and post-traumatic stress disorder) should be sought via screening tools e.g. Hospital Anxiety Depression Scale (HADS), and UK Post Traumatic Stress Syndrome score (UK PTSS-14). This could be facilitated by review of clinical notes with patients and family or patient diary, use of screening questionnaires and review by a clinical psychologist.","Met = screening process in place for psychological seq for all patients, partially = for selected patients, unmet = no screening",null,"RECOMMENDATIONS",3.7]
[8,"Following structured review, appropriate referrals to other services may be required and should be arranged where required.","met- referaal from clinic / not met - referral via GP",null,"RECOMMENDATIONS",3.7]
[9,"A bereavement follow-up service should be offered where explanations of diagnoses, treatments and support can be provided.","met / not met",null,"RECOMMENDATIONS",3.7]
[10,"The establishment of a critical care patient and relatives support group should be encouraged.","met / not met",null,"RECOMMENDATIONS",3.7]
[11,"Patients and relatives should be surveyed regularly and this information should be utilised to assess rehabilitation and follow-up services.","see other standards ",null,"RECOMMENDATIONS",3.7]
[null,null,null,null,"-"]
[null,null,null,null,"-"]
[3.8,"The Patient and Relative Perspective",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"All patients must be regularly assessed for the presence of pain which should be managed with a protocolised multimodal analgesic regimen.\n\n",null,null,"STANDARDS",3.8]
[2,"The effects of delirium must be explained to patients and their families and this should be emphasised in follow-up visits post critical care. Written information about delirium must be provided. ","met - all elements done, relatives provided with written info, Partially met - some elements done or not all familes, not met - not done",null,"STANDARDS",3.8]
[3,"When patients are sedated or unconscious or have delirium and require any intervention or nursing care, staff must explain to them in simple terms what they are doing. ","met = Unit has guideline/protocol for delirium prevention/management that includes these measures and is included in  induction training for staff / not met",null,"STANDARDS",3.8]
[4,"Critical care staff must offer patients ways to help improve the quality of their sleep, for example eye masks and ear plugs.  Staff must try to minimise light and noise during the night.","met - guideline in place and done , partially met - some elements but not comprehensive or systematically applied, not met - not done ",null,"STANDARDS",3.8]
[5,"Patients and families must be given high quality verbal and written information while the patient is in critical care (such as information about the patient’s treatment, what the patient might experience and how they might feel) and when they leave the unit (to help explain what has happened to the patient and what might help them in their recovery).   Each unit must have such documents readily available and ready for patients and relatives. Young visitors and their parents will need specific support.","met = written and >75% families having a formal documented communication, partially 50-75%, unmet = no written info and/or <50% having formal communication",null,"STANDARDS",3.8]
[6,"Patients must be given help to communicate (e.g. speaking valves (for patients with a tracheostomy, wipe boards or flash cards).","met = SLT involved and have full range of communication aids available / partially met = limited access to speech and language / not met"]
[7,"Critical care units must have policies about how to safeguard vulnerable adult patients.","met /  not met ",null,"STANDARDS",3.8]
[8,"Units must obtain regular feedback about the care that patients and relatives received during their critical care admission in order to learn from and act on the feedback received.",null,null,"STANDARDS",3.8]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Intensive care patients should have a patient diary. ","met = >90% patients >48h stay, partial = only longer stay or <90%, unmet no diary",null,"RECOMMENDATIONS",3.8]
[2,"Understanding the individual who has become critically ill is important to help their treatment and recovery. A ‘This Is Me’ board or document for each patient is very beneficial and should be used if possible. ","met / not met",null,"RECOMMENDATIONS",3.8]
[3,"Intensive care and ward staff should have training in what intensive care is like for patients and relatives and what challenges patients face while in intensive care and during their rehabilitation.  Asking former patients and relatives to help with this training is beneficial.","met / not met",null,"RECOMMENDATIONS",3.8]
[4,"Intensive care staff should let relatives know how they can help the patient, for example by talking to or reading to the patient (even if the patient is unconscious or sedated), as a familiar voice can be reassuring.  Relatives should also be allowed to help with simple aspects of caring for the patients, if they would like to, such as applying hand cream or brushing hair. Written information should be provided for relatives.","met / not met",null,"RECOMMENDATIONS",3.8]
[5,"Intensive care staff should spend time talking to the patient and relatives, seeing how they feel, asking about any worries they have and checking their understanding of any information that has been given.  Clear information should be given to relatives regarding when they can visit.","met / not met",null,"RECOMMENDATIONS",3.8]
[6,"A room should be provided for relatives to wait in or have time away from the unit. This room should be comfortable and its facilities regularly reviewed. Feedback should be sought from families whether additional facilities and support are required.","met - relatives room, partially met, relatives room but poor facilities, not met - no dedicated relatives room ",null,"RECOMMENDATIONS",3.8]
[7,"On discharge from the critical care unit, patients should be given the contact details of the healthcare professionals who are co-ordinating the patient’s rehabilitation pathway. ","met / unmet ",null,"RECOMMENDATIONS",3.8]
[8," All patients should be visited by a critical care outreach team, who can help with the transition from Critical Care to ward this transition. ","met / not met",null,"RECOMMENDATIONS",3.8]
[9,"Intensive care patients should have access to formal support provided by the critical care service after they leave.  ie critical care followup / outreach services","met / not met",null,"RECOMMENDATIONS",3.8]
[10,"Critical care units should provide relatives of patients who died in intensive care the opportunity of a follow-up meeting with an ICU staff member to discuss any questions they may have about their relative’s time on the unit. Families may be given a leaflet after their relative dies in order that they can arrange a meeting at a later date if they wish to.  It can also include other sources of support. Some units hold memorial services for relatives.","met / not met",null,"RECOMMENDATIONS",3.8]
[null,null,null,null,"-"]
[3.9,"Staff Support",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"All units must have policies in place to support staff engagement and retention.","met / not met",null,"STANDARDS",3.9]
[2,"Induction and escalation policies must be clearly identified for all staff groups.","met / not met",null,"STANDARDS",3.9]
[3,"100% of new staff must receive a job-specific induction to the unit.","met / not met",null,"STANDARDS",3.9]
[4,"Workplace equity within staff groups must be transparent (e.g. rostering, annual leave policies, job plans). Staff must be aware of the policies.","met /  not met ",null,"STANDARDS",3.9]
[5,"Staff well-being is an organisational priority. Units must monitor and regularly review metrics of staff well-being as quality indicators (e.g. sickness rates).","met - quartlerly , partially met 1-2 yrs, unmet - not monitored or mroe than 2 yearly intervals",null,"STANDARDS",3.9]
[6,"All staff must have opportunities for personal development reviews including annual appraisals.","met - > 85% of staff appraised / PDP done, Partially met 75-85%  not met < 75% of staff",null,"STANDARDS",3.9]
[7,"All staff working in critical care must be able to access the Freedom to Speak Up Guardian.","met /  not met ",null,"STANDARDS",3.9]
[8,"Staff must be provided with adequate resources consistent with other GPICS standards to deliver their job role, e.g. adequate staffing ratios, access to facilities for nutrition and hydration, adequate equipment.","Statement"]
[9,"Staff rostering must comply with Health and Safety Executive recommendations for sleep and rest.","met /  not met ",null,"STANDARDS",3.9]
[10,"Units must provide adequate workplace facilities for staff breaks, which are separated from areas for relatives.","met /  not met ",null,"STANDARDS",3.9]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"All staff engaged in a managerial or leadership role should have access to appropriate mentoring and/or coaching services to support them in their role.","met / not met",null,"RECOMMENDATIONS",3.9]
[2,"All units should promote healthy rest and sleep policies for staff required to work overnight.","met / not met",null,"RECOMMENDATIONS",3.9]
[3,"All staff members should have access to an independent, professional psychological support service, which provides counselling services.","met /  not met ",null,"RECOMMENDATIONS",3.9]
[4,"All staff members should have self-referral access to an occupational health service and rapid access physiotherapy services.","met /  not met ",null,"RECOMMENDATIONS",3.9]
[5,"All units should provide frequent opportunities for shared learning, clinical communication, and reflection, to reduce professional isolation.  This includes routine clinical practice (e.g. multidisciplinary rounds, mortality and morbidity meetings), as well as specific reflective events (e.g. Schwartz Centre Rounds, debriefing following medical emergencies).","met /  not met ",null,"RECOMMENDATIONS",3.9]
[6,"All staff should have ergonomic clinical work areas with appropriate access to light and control of noise.","met /  not met ",null,"RECOMMENDATIONS",3.9]
[7,"All staff should be supported to maintain a healthy lifestyle, e.g. provision of advice on diet and exercise.","met /  not met ",null,"RECOMMENDATIONS",3.9]
[8,"All units should conduct regular (at least annual) reviews of organisational policy on staff health and well-being.","met /  not met ",null,"RECOMMENDATIONS",3.9]
[null,null,null,null,"-"]
[3.1,"Inter and Intra and Hospital Transfer of Critically Ill Patients",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
["1","Transfer to other critical care units for non-clinical reasons must be avoided where possible.",null,null,"STANDARDS",3.101]
[2,"Appropriate equipment must be available to undertake a safe transfer and to manage complications/adverse events which may occur during a transfer. All equipment used for patient transfers must conform to the relevant safety standards, be regularly serviced, and checked immediately before use.","met / not met",null,"STANDARDS",3.101]
[3,"All staff involved in a patient transfer must be trained, competent and familiar with the use of equipment. ","met / not met",null,"STANDARDS",3.101]
[4,"Where patient transfers result in a change of team managing the patient during or following a transfer, an appropriate and documented handover must be undertaken between the teams to ensure good continuity of care. This should include providing copies of the clinical record.","met / not met",null,"STANDARDS",3.101]
[5,"A named intensive care consultant must take overall responsibility for the decision to transfer a patient and the level of support required, but does not necessarily have to undertake the transfer.","met / not met ",null,"STANDARDS",3.101]
[6,"Inter-hospital transfers must be undertaken in a timely fashion according to the patient’s clinical condition.","met / not met",null,"STANDARDS",3.101]
[7,"For inter-hospital transfers, there must always be a named consultant who will take responsibility for the patient on arrival at the receiving hospital. This must be agreed prior to the transfer being undertaken.","met / not met ",null,"STANDARDS",3.101]
[8,"Where patients have completed specialist care and ongoing intensive care needs can be provided in the patient’s home, hospital transfer must take place within 48 hours of referral to the receiving hospital.","Percentge occuring within 48 hours of decision.  Met > 85%,  partailly met 75-85%, not met < 75% of the time or no data collected. ",null,"STANDARDS",3.101]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Transfers should follow the advice and protocols presented in the latest ICS transfer guidance.","met - meet standard, partially met, dont meet standard but risk assessment in place , not met.. dont meet standard and no risk assessment ",null,"RECOMMENDATIONS",3.101]
[2,"The reason for any transfer should be documented in the patient’s notes. This should include an assessment of potential benefits against risks. Transfer decisions should only be made by consultant intensive care team members, and this information should also be documented.","met = documented 95%, partially met 80-95%, unmet <80% or no data or not a consultnat decision",null,"RECOMMENDATIONS",3.101]
[3,"An adequately stocked and regularly checked, dedicated transfer bag should be available for use during all patient transfers. This bag should contain appropriate drugs and equipment for interventions that might be required in transit. The transfer bag contents should be checked routinely (ideally daily and a log of checks maintained) or, if sealed with a tag, then a daily check that the seal is unbroken. The transfer bag must be restocked between uses to avoid delays when it is needed. Staff carrying out patient transfers should be familiar with bag layout and content.","met = checked with log and tagged, partially = daily check but not tagged or logged, unmet = no checking or significant deficiencies in kit available",null,"RECOMMENDATIONS",3.101]
[4,"The patient’s vital signs should be documented at appropriate intervals while in transit. Where possible, action should be taken to remedy any physiological deterioration during the transfer.","met = audit evidence of obs or transfer forms, unmet = no evidence",null,"RECOMMENDATIONS",3.101]
[5,"Standardised transfer documentation should be completed for all intensive care patient transfers. Transfer documentation should be scrutinised within a robust audit system, allowing eventful or substandard transfers to be investigated and lessons learnt to be shared widely, as well as numbers and reasons for transfers.","met = use of a network wide agreed form or electronic recording system, unmet = no standard system",null,"RECOMMENDATIONS",3.101]
[6,"Where an adverse event occurs during a transfer, this should be reported and investigated using the healthcare organisation incident reporting system at the transferring unit. All learning should be widely shared.","met / not met ",null,"RECOMMENDATIONS",3.101]
[7,"Every acute healthcare organisation should have a designated consultant and nurse who are responsible for maintaining standards of transfer of critical care patients, guideline production, training, governance, audit and reporting.","met - both, partially met - one, not met - none",null,"RECOMMENDATIONS",3.101]
[8,"Training in transfer medicine should be an integral part of Intensive Care Medicine training for doctors and nurses.","Statement"]
[9,"Where multiple teams are involved in a patient’s care, appropriate handover should be undertaken between the teams prior to transfer. This should not delay the transfer.","met /  not met ",null,"RECOMMENDATIONS",3.101]
[10,"The patient, where possible, and their next-of-kin should be informed of the decision to transfer and an explanation given to them of the need for transfer. This discussion should be documented.","met = 95%, partially = 80-95%, unmet <80% documented",null,"RECOMMENDATIONS",3.101]
[11,"There should be a clear agreed escalation process for any delayed transfer across an operational delivery network geographical area. The definition of ‘delay’ will vary according to the reason for the transfer. For patients being transferred from a specialist critical care unit to a general critical care unit at the completion of specialist care, a delayed transfer is one that has not been undertaken 48 hours after the time of referral to the general critical care unit.","met /  not met ",null,"RECOMMENDATIONS",3.101]
[12,"Appropriate infection control precautions, including isolation, must be made available for patients with known high-risk infections or who are at a high risk of harbouring such infections both during transfer and in the receiving hospital; their availability should be such that this does not delay a patient transfer. Similarly, isolation facilities must be available for immunocompromised patients who require them.","met / not ",null,"RECOMMENDATIONS",3.101]
[13,"Critical care units should have an agreement with their local ambulance providers in relation to the contracted transport provision for intensive care services, and to ensure these standards are met throughout the entire patient pathway.","met /  not met ",null,"RECOMMENDATIONS",3.101]
[14,"There should be a system for monitoring the quality of inter hospital transfers and governance arrangements which includes capture of numbers, indication for transfer, incidents, delayed transfers and outcomes. Audit measures and learning should be widely shared.","met - well established processes, data avaiable, partially met - reviewed, limited data available, not met. rarely undertaken or not at all",null,"RECOMMENDATIONS",3.101]
[15,"There should be standardised network wide transfer documentation and training programmes.","met = both / partially met = one or the other / not met = neither "]
[16,"Consideration should be given to the formation of specialist transfer teams, as these may reduce the incidence of adverse events and prevent the adverse impact of transfers on the transferring unit due to loss of key staff. ","Statement"]
[null,null,null,null,"-"]
[3.11,"Care at the End of Life",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Decision making surrounding care at the end of life, including the rationale for any decisions, must be documented clearly and communicated to patients and their loved ones.  The latter being of particular relevance if patients lack capacity (below).","met = 98% with clear documentation, partially = 95-98% documented but gaps found in documentation on audit, unmet = <95% or major failings in what is documented",null,"STANDARDS",3.11]
[2,"Decision making surrounding end of life care (EoLC) must be performed in accordance with relevant statutory requirements and professional guidance: a) Mental Capacity Act 2005 (MCA 2005), England and Wales, b) Adults with Incapacity Act (2000), Scotland, c) Mental Capacity Act (Northern Ireland) 2016, d) Human Tissue Act, England, e) General Medical Council’s Good Medical Practice; specifically Treatment and Care Towards the End of Life: Good Practice in Decision Making.","met /  not met ",null,"STANDARDS",3.11]
[3,"Declaration of death by cardiorespiratory or neurological criteria must be done in accordance with professional guidance.","met /  not met ",null,"STANDARDS",3.11]
[4,"Consideration must be made as to whether organ and tissue donation can be offered to every dying patient, and where appropriate the specialist nurse-organ donation (SNOD) should be contacted.","met = considered with audit data on referral rates reviewed quarterly, partially = considered but no audit data or <70% referral rate, unmet = not done",null,"STANDARDS",3.11]
[5,"In order to identify dying patients and respond to changes in their condition, those at high risk of dying must have their condition regularly reviewed to assess whether they are improving or deteriorating, enabling early and appropriate organisation of treatment and care.","Statement"]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Patients with capacity should be kept informed of their clinical condition, and of the possibility that they may be dying.  Best practice dictates that those close to the patient should also be informed.","met / not met",null,"RECOMMENDATIONS",3.11]
[2,"Decision making related to care at the end of life should, wherever possible, involve patients and people close to them, as well as medical professionals. If the patient lacks capacity and there is no individual with Lasting Power of Attorney, responsibility for determining treatments rests with treating clinicians.  Previous decisions should also be taken into account e.g. treatment escalation plans (TEP), ReSPECT (Recommended Summary Care Plan for Emergency Care and Treatment).","met / not met",null,"RECOMMENDATIONS",3.11]
[3,"At least two consultants, supported by senior ICU nursing agreement, should contribute to the process of recommending withdrawal or withholding treatments.  Such processes are decided on a case-by-case basis and clarity of communication can be improved by outlining likely burdens and benefits of acts or omissions.","met - 7 days per week, partially met 5 days per week, ",null,"RECOMMENDATIONS",3.11]
[4,"Once patients are recognised as being in their final days/hours of life, therapeutic goals should be reviewed and accordingly altered to focus on comfort and dignity.  Interventions which do not contribute towards this should be withdrawn.  The discussion of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) is intrinsic to palliative care in critically ill patients.  This should be discussed with patients and families within that context.  If instituted in emergent situations for incapacitated patients, DNACPR decisions should be discussed with patients’ surrogates (as defined by the MCA or equivalent) at the earliest opportunity.  The British Medical Association, Resuscitation Council-UK and Royal College of Nursing issue regularly updated guidance on DNACPR.","met = systematic documentation used 95%, partially 90-95% or no systematic documentation, unmet no evidence",null,"RECOMMENDATIONS",3.11]
[5,"Dying patients should be managed by multi-professional teams that include senior medical and nursing staff from intensive care and referring teams. It may also include specialist palliative care teams.","met / not met ",null,"RECOMMENDATIONS",3.11]
[6,"Therapeutic plans should be made and anticipatory medications prescribed for all patients in their final hours/days of life, enabling prompt symptom control.  This includes therapeutic options for analgesia, dyspnoea, anxiety and agitation.  Doses should be titrated for symptom relief based on explicit assessments. Where appropriate, the double effect of drugs used should be transparent to patients, staff and family.","met = systematic documentation used 95%, partially 90-95% or no systematic documentation, unmet no evidence",null,"RECOMMENDATIONS",3.11]
[7,"Care should address dying patients’ need for spiritual and emotional support, and include that of their families and others close to them. The needs of loved ones to be with, care for and otherwise attend to dying patients should be met as far as is possible.  If appropriate, religious or secular expertise should be sought (e.g. referral to chaplaincy, psychological services or patients’ GPs).  Staff should also have access to these support services.","met / not met ",null,"RECOMMENDATIONS",3.11]
[8,"If death is considered to be very close, patients should not normally be transferred out of the critical care unit unless it is to facilitate (via discussion with patients and loved ones) significant improvements in care.  If practical to do so, patients should be given the opportunity to die at home or in a hospice. All transfers should involve a handover of plans and goals of care.","met / not met ",null,"RECOMMENDATIONS",3.11]
[9,"Intensive care clinicians often have a responsibility for decision making and care of acutely unwell and deteriorating patients outside of the critical care unit.  When reviewing such patients for potential treatment escalation, they should work with patients’ clinical teams to ensure that decisions and communication regarding care at the end of life are made to the same standards as on the critical care unit.","met / not met ",null,"RECOMMENDATIONS",3.11]
[null,null,null,null,"-"]
[null,null,null,null,"-"]
[3.12,"Organ Donation",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"If a patient is close to death, doctors must explore with those close to them whether they had expressed any views about organ or tissue donation. Doctors must follow any national procedures for identifying potential organ donors and, in appropriate cases, for notifying the Specialist Nurse-Organ Donation (SNOD).","met = routinely done with collaborative requesting when possible, partially met = routinely done but not with collaborative requesting, unmet = poor results on referral rates",null,"STANDARDS",3.12]
[2,"The National Institute for Health and Clinical Excellence guidance requires that the intensive care team caring for the patient should initiate discussions about potential organ donation with the SNOD whenever a patient meets the criteria for undertaking the tests, to confirm death using neurological criteria or when there is an intention to withdraw life-sustaining treatment in patients with a life-threatening or life-limiting condition which will, or is expected to, result in circulatory death.","met >85% of the time, partially met 75-85% of the time, un met < 75% of the time or no data collected. ",null,"STANDARDS",3.12]
[3,"Critical care units must comply with the criteria for diagnosing death using neurological or circulatory criteria as set by the Academy of Medical Royal Colleges. ","met /  not met ",null,"STANDARDS",3.12]
[4,"All units must contribute data to the national potential donor audit.","met /  not met ",null,"STANDARDS",3.12]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Each acute hospital should have an Organ Donation Committee to oversee all aspects of deceased organ donation as recommended by the Department of Health’s Organ Donation Taskforce.  Funding for the committee’s activities is provided by NHS Blood and Transplant (NHSBT).","met /  not met ",null,"RECOMMENDATIONS",3.12]
[2,"Each acute hospital should have a clinical lead for organ donation (CLOD) funded by NHSBT, with responsibility to implement organ donation policies, promote the adoption of best practice guidelines and to address any local barriers to donation.","met /  not met ",null,"RECOMMENDATIONS",3.12]
[3,"Each critical care unit should have an embedded or assigned SNOD employed by NHSBT to provide advice on all issues relating to donation, organise donor coordination, support the intensive care staff in donor management, complete the potential donor audit, engage in teaching and training and support donor families.","met /  not met ",null,"RECOMMENDATIONS",3.12]
[4,"Guidelines on end of life care and withdrawal of life-sustaining treatments (WLST) should be compliant with the Mental Capacity Act 2005, and based on the guidance provided by the General Medical Council, and should be followed irrespective of any potential for organ donation. Determining best interests at the end of life should include an assessment of a patient’s preferences and wishes regarding organ donation. Guidance on decisions regarding WLST in patients with devastating brain injury (DBI) should be based on the recommendations of FICM/ICS and other professional bodies. ","met /  not met ",null,"RECOMMENDATIONS",3.12]
[5,"A planned and collaborative approach to the family for organ donation between the intensive care team and the SNOD team should be routine practice as recommended by NICE in 2016. ","met /  not met ",null,"RECOMMENDATIONS",3.12]
[6,"Consultants in Intensive Care Medicine should actively manage brain stem dead consented donors to optimise organ quality and increase the number of organs successfully retrieved and transplanted. Donor optimisation care bundles or protocols should be available and used.","met /  not met ",null,"RECOMMENDATIONS",3.12]
[7,"The intensive care team should manage resources flexibly to facilitate organ donation and/or end of life care for patients outside the critical care unit whenever appropriate.","met /  not met ",null,"RECOMMENDATIONS",3.12]
[null,null,null,null,"-"]
[null,null,null,null,"-"]
[3.13,"Legal Aspects of Capacity and Decision Making",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Units must have regular, minuted, multidisciplinary team meetings to review cases where dispute have or may have arisen.","met /  not met ",null,"STANDARDS",3.13]
[2,"All patients must be presumed to have capacity to consent or withhold consent.","Statement"]
[3,"If the patient has made a valid and applicable Advance Decision Refusing Treatment (ADRT), it must be respected (although an ARDT does not have formal legal standing in Scotland, they are likely to be highly persuasive to the court).","Statement"]
[4,"Final determination of capacity for a specific treatment must be made by the treating clinician and documented.","Statement"]
[5,"If a patient has capacity, their decision must be respected, even if the treating clinician considers the decision to be unwise.","Statement"]
[6,"Patients who lack capacity must only be treated in their best interests (England & Wales) or if it is of benefit to the patient (Scotland).","Statement"]
[7,"Determination of best interests/benefit must involve consultation between the treating consultant and individuals close to the patient (family and friends).","Statement"]
[8,"The aim is to achieve consensus between team and family/friends as to what is in the best interests/benefit to the patient. When there is continued disagreement about best interests/benefit, the treating clinician must not act unilaterally.","Statement"]
[9,"If, at the end of the medical process, it is apparent that the way forward is finely balanced, or there is a difference of medical opinion, or a lack of agreement to a proposed course of action from those with an interest in the patient’s welfare, a court application must be made.","Statement"]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"A written departmental protocol for resolution of disagreements should be in place. Disagreements may be within the team, between different clinical teams or between team and family/friends.","met /  not met ",null,"RECOMMENDATIONS",3.13]
[2,"An ADRT that does not meet the criteria to be formally legally binding should nevertheless be taken into account as part of the best interests assessment as a strong indication of the patient’s wishes and opinions.","Statement"]
[3,"In situations of intractable disagreement, mediation should be considered prior to approaching the Court of Protection (England & Wales)/Court of Session (Scotland). NHS Resolution or the Civil Mediation Council provide access to individual mediators or recognised groups.","Statement"]
[4,"Independent Mental Capacity Advocates (IMCA) should be consulted (in England and Wales) when a patient is ‘unbefriended’. This only applies when there is no one who can be consulted about best interests, i.e. no family or friends. IMCAs should not be consulted because there is dispute about best interests between the medical team and family. ","Statement"]

{"sheet":"Clinical Care","index":6,"n_rows":250,"n_cols":7,"rows_kept":250,"cut":false,"hidden":false,"merged":[]}
["Section 4","CRITICAL CARE SERVICES: CLINICAL CARE","Level description","Level","Hidden","Hidden","Comments"]
[null,null,null,null,"-"]
[4.0999999999999996,"Respiratory Support",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Units must have access to sufficient modern invasive and non-invasive ventilators which will support pressure/volume controlled ventilation, titration of inspired oxygen concentration, support spontaneous ventilation and allow application of PEEP.","met / not met",null,"STANDARDS",4.0999999999999996]
[2,"Pulse oximetry, capnography, ECG, blood pressure monitoring and ventilator alarms must be used for all ventilated patients whose trachea is intubated.","met / not met",null,"STANDARDS",4.0999999999999996]
[3,"An accurate height must be measured on admission for every patient requiring invasive mechanical ventilation to calculate predicted body weight (PBW) and corresponding target tidal volume to allow protective ventilation (6ml/kg PBW in those with ARDS or at risk of ARDS).","met / not met",null,"STANDARDS",4.0999999999999996]
[4,"Units must have evidence-based, written guidelines covering the use of non-invasive ventilation, the management of ARDS, prevention of ventilator-associated pneumonia and weaning from ventilation (including the use of sedation).","met - guidelines for all and review date within last 3 years , partially met - one or more gudielines missing or not reviewed within the last 3 years, not met - limited guidlines and / or older than 3 years ",null,"STANDARDS",4.0999999999999996]
[5,"Referral pathways for patients with severe but potentially reversible acute hypoxaemic respiratory failure must be in place with Regional Extra-corporeal Membrane Oxygenation-capable (ECMO) Centres. ","met / not met",null,"STANDARDS",4.0999999999999996]
[6,"Units must have written guidelines on the indication, risks and practice of prone positioning in hypoxaemic respiratory failure.","met / not met",null,"STANDARDS",4.0999999999999996]
[7,"Units must have immediate access to point-of-care testing to enable arterial blood gas analysis.","met ABG machine on unit or within easy use, with a backup within 5 mins of unit or >1 machine, partially = single ABG machine with backup machine 5-30 minutes away or 24/7 on call repairs within 30 mins, unmet = no on site backup and service >3",null,"STANDARDS",4.0999999999999996]
[8,"Standard operating procedures, including checklists, should be developed for intubation, extubation, bronchoscopy, prone positioning, tracheostomy and any high risk/invasive procedures. ","met - guidelines for all and review date within last 3 years , partially met - one or more gudielines missing or not reviewed within the last 3 years, not met - limited guidlines and / or older than 3 years ",null,"STANDARDS",4.0999999999999996]
[9,"Non-invasive ventilation must be considered and available for patients with acute hypercapnic respiratory failure.","met / not met",null,"STANDARDS",4.0999999999999996]
[10,"High flow nasal oxygen must be available for the management of patients with acute hypoxaemic respiratory failure.","met / not met",null,"STANDARDS",4.0999999999999996]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Tidal volume (ml/kg PBW), plateau airway pressures and cumulative fluid balance should be monitored and recorded daily in all patients requiring invasive ventilation.","met - all recorded daily , partially met - one / two not recorded daily, not met - more than two not recorded ",null,"RECOMMENDATIONS",4.0999999999999996]
[2,"Audit of compliance with ARDS, ventilator associated pneumonia and weaning guidelines should be undertaken quarterly.","met / not met",null,"RECOMMENDATIONS",4.0999999999999996]
[3,"Units should have standardised systems to monitor VAP rates and antibiotic resistance patterns.","met / not met",null,"RECOMMENDATIONS",4.0999999999999996]
[4,"There is insufficient evidence at present to inform clinicians about the role of Extracorporeal Carbon Dioxide Removal (ECCO2R) in acute hypoxaemic respiratory failure and ARDS. Patients should only receive ECCO2R within the governance framework set out in NICE Guidance.","met / not met",null,"RECOMMENDATIONS",4.0999999999999996]
[null,null,null,null,"-"]
[4.2,"Weaning from Prolonged Mechanical Ventilation and Long-Term Home Ventilation Services",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Level 3 units must have access to a regional home ventilation and weaning unit. Arrangements must be in place to collaboratively manage patients with weaning difficulties and failure, including the transfer of some patients with complex weaning problems to the Regional Centre.","met / not met",null,"STANDARDS",4.2]
[2,"Units must hold multi-professional clinical governance meetings, including analysis of mortality and morbidity. ","met / not met",null,"STANDARDS",4.2]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Patients with potential weaning problems should be identified at an early stage of admission. Most will have significant respiratory or neurological co-morbidities. Patients with slowly deteriorating neurological conditions are at particular risk of weaning failure.","met / not met",null,"RECOMMENDATIONS",4.2]
[2,"Patients should be managed by a multi-professional intensive care team with specialist expertise and experience in managing patients with weaning problems and consisting of senior medical, nursing, physiotherapy, speech and language therapy, and dietitian members.","met = full MDT routinely used, partial = 1-2 MDT professions not routinely involved",null,"RECOMMENDATIONS",4.2]
[3,"These patients should be managed in a consistent manner by the use of structured weaning plans, including sedation management, based on agreed protocols. ","met protocols in place and audited, partially met = protocols in place but not audited, not met = no protocols in place/not reviewed in last 2 years",null,"RECOMMENDATIONS",4.2]
[4,"Early mobilisation and rehabilitation are likely to prevent weaning delay and failure. Units should have protocols in place and resources to provide these services as described in the section of this document on rehabilitation (Chapter 3.6).","met / not met",null,"RECOMMENDATIONS",4.2]
[5,"The use of non-invasive ventilation (NIV) as a bridge to spontaneous breathing should be considered in selective groups. Resources and skill in NIV should be available in all units managing patients with prolonged ventilatory needs.","met / not met",null,"RECOMMENDATIONS",4.2]
[6,"Early discussion with regional domiciliary ventilation services should occur in any patient with chronic neuromuscular impairment, and in those requiring more than 21 days of ventilation. Regional weaning centres should offer advice to referring units to assist with weaning .","met / not met / NA if no regional weaning service ",null,"RECOMMENDATIONS",4.2]
[7,"The transfer of some patients with weaning delay and failure should be discussed with regional weaning/home-ventilation centres and protocols should be in place to aid these decisions.","met / not met / NA if no regional weaning service ",null,"RECOMMENDATIONS",4.2]
[null,null,null,null,"-"]
[null,null,null,null,"-"]
[4.3,"Renal Support",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Critical care units must have the necessary facilities and expertise to provide acute RRT for patients with AKI on a 24/7 basis.","met / not met",null,"STANDARDS",4.3]
[2,"Patients receiving acute RRT, where the cause of AKI is unclear or where RRT will be needed on intensive care discharge, must be discussed with the local renal team as per the NICE guideline.","met / not met",null,"STANDARDS",4.3]
[3,"Patients receiving acute RRT must be cared for by a multi-professional team that is trained and experienced in delivering and monitoring RRT.","met / not met",null,"STANDARDS",4.3]
[4,"Acute RRT for patients with progressive or severe AKI must be started before the onset of life-threatening complications associated with renal dysfunction.","met / not met",null,"STANDARDS",4.3]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"The decision to initiate RRT should be based on the condition and prognosis of the patient as a whole, and not on isolated urea or creatinine values as per Kidney Diseases Improving Global Outcomes (KDIGO) recommendations and the NICE guideline.","met / not met",null,"RECOMMENDATIONS",4.3]
[2,"Where life-threatening complications of AKI occur, such as intractable hyperkalaemia, RRT should be started emergently unless a decision has been made not to escalate therapy.","met / not met",null,"RECOMMENDATIONS",4.3]
[3,"Patients with end-stage renal failure who are not in a renal unit/dialysis centre and require urgent RRT may require critical care admission.  In such cases, there should be close liaison with the regional renal service regarding transfer and vascular access.","met / not met",null,"RECOMMENDATIONS",4.3]
[4,"Continuous and intermittent RRT should be considered as complementary therapies for AKI. The choice of therapy should be based on patient status, expertise of the clinical staff and availability of machines.","met / not met",null,"RECOMMENDATIONS",4.3]
[5,"The dose of RRT should be prescribed at the beginning of the RRT session. It should be reviewed daily and tailored to the needs of the patient.","met = clear standardised RRT prescription with evidence of daily review and audit, partial = done but not clearly evidenced, no audit, unmet = no standardised RRT prescription",null,"RECOMMENDATIONS",4.3]
[6,"The decision to use anticoagulation to maintain circuit patency and the choice of anticoagulant should be based on the potential risks and benefits in an individual patient, the expertise of the clinical team and the options available. KDIGO guidelines suggest using regional citrate anticoagulation for CRRT rather than heparin in patients who do not have contraindications for citrate.","citrate anticoagulation should be available Met/unmet",null,"RECOMMENDATIONS",4.3]
[7,"Bicarbonate, rather than lactate should be used as a buffer in dialysate and replacement fluid for acute RRT.","met / Partially met = daily prescription chart but compliance not audited / not met",null,"RECOMMENDATIONS",4.3]
[8,"Drug dosing may need adjusting whenever RRT is started or the RRT prescription is altered. Close collaboration with an intensive care pharmacist with suitable experience in AKI and the effects of RRT is essential.","met / not met",null,"RECOMMENDATIONS",4.3]
[9,"Patients treated with acute RRT should receive standard enteral nutrition as long as there are no significant electrolyte abnormalities or fluid overload refractory to RRT.","met / not met",null,"RECOMMENDATIONS",4.3]
[10,"When discharged from critical care, the accepting team and GP should be informed that the patient had received RRT for AKI while in intensive care so that appropriate follow-up arrangements can be made.","met / not met",null,"RECOMMENDATIONS",4.3]
[null,null,null,null,"-"]
[4.4000000000000004,"Gastrointestinal Support and Nutrition",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"The type and position of nasogastric feeding tubes (NGTs) used for enteral feeding, hydration and/or drug administration, must comply with NHS Improvement guidelines. ","met / not met",null,"STANDARDS",4.4000000000000004]
[2,"Intensive care services must have a nutrition support guideline with institutional strategies to promote nutrition delivery and to overcome EN intolerance. It is suggested that it should include: a) Measures to minimise the risk of EN aspiration, b) Criteria for the use of prokinetic medications, c) Criteria for naso-jejunal feeding, d) Criteria for use of parenteral nutrition, e) Consistent times for stopping and restarting EN around anaesthetic, surgical or bedside procedures and f) A protocol for initiation of nutrition without waiting for a dietitian’s plan.","met = clear guideline in place meeting these criteria, partial = guideline in place with some omissions or >3y since review, unmet = no guideline or fails many of these criteria",null,"STANDARDS",4.4000000000000004]
[3,"Intensive care services must have guidance in place relating to the identification of, and nutrition support for, those at risk of re-feeding syndrome.","met = clear guideline in place meeting these criteria and audit evidence, partial = guideline in place with some omissions or >3y since review or no audit evidence, unmet = no guideline or fails many of these criteria",null,"STANDARDS",4.4000000000000004]
[4,"Intensive care services must ensure that there is access to a range of parenteral nutrition bags which include vitamins, trace elements and minerals. A ‘standard’ bag of parenteral nutrition must be available within 24 hours.","met = all elements listed, partial = TPN available but limited range, unmet = not available or a single standard bag only available",null,"STANDARDS",4.4000000000000004]
[5,"Intensive care services must have access to a range of enteral nutrition products to include: a) Low electrolyte, b) High protein, c) Fluid restricted and d) 'Tolerance' (semi-elemental)","met / not met",null,"STANDARDS",4.4000000000000004]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Nutritional status and risk should be assessed on admission, and energy, protein and micronutrient needs determined by a critical care dietitian or clinician with appropriate specialist training or experience. ","met / not met",null,"RECOMMENDATIONS",4.4000000000000004]
[2,"It is recommended that nutrition support (PN if EN is not possible) should be instigated within 48 hours in patients expected not to be on a full oral diet within three days.","met / not met",null,"RECOMMENDATIONS",4.4000000000000004]
[3,"Nutritional intake targets should be set and compared daily with actual intake. Deficits should be monitored and steps taken to remedy them.","met / not met",null,"RECOMMENDATIONS",4.4000000000000004]
[4,"Efforts need not be made to cover full energy targets with EN or PN until clinical stability has been achieved. Delivering a calorie load which exceeds energy expenditure appears harmful and should be avoided, whereas hypocaloric nutrition may be safe initially.","met / not met",null,"RECOMMENDATIONS",4.4000000000000004]
[5,"The energy content from certain drugs (e.g. Propofol, IV glucose and citrate anti-coagulation renal replacement therapy) should be accounted for to avoid overfeeding.","met / not met",null,"RECOMMENDATIONS",4.4000000000000004]
[6,"Feeding plans should be adjusted for those with a BMI > 30 kg/m2 according to international guidelines.","met / not met",null,"RECOMMENDATIONS",4.4000000000000004]
[7," Volume-based or ‘catch up’ feeding should be used to allow nursing staff to adjust the hourly infusion rate of EN to optimise delivery after interruptions.","met / not met",null,"RECOMMENDATIONS",4.4000000000000004]
[8,"There should be access to nasal bridles to secure NGTs in agitated patients and guidelines for their use and aftercare.","met / not met",null,"RECOMMENDATIONS",4.4000000000000004]
[9,"Nutrition support targets should be included in the rehabilitation of critically ill patients.","met / not met",null,"RECOMMENDATIONS",4.4000000000000004]
[10,"There should be bowel management guidelines which include: a) Regular monitoring and documentation of bowel habits (frequency & type), b) Minimising the use of drugs that can cause constipation or diarrhoea, c) The need for rectal examinations and treating faecal loading/impaction, d) When to use laxatives, enemas and suppositories, e) Management of ileus.","met = bowel management guideline and audited, partially met = protocol but not audited, unmet - no guideline",null,"RECOMMENDATIONS",4.4000000000000004]
[null,null,null,null,"-"]
[4.5,"Liver Support",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Contact with regional liver and or liver transplant centre must be made early following admission to a critical care unit of a patient with ACUTE liver failure. Advice about management, prognosis and possible transfer can be discussed.","Statement"]
[2,"Patients with ALF must be managed in a liver transplant centre if liver transplantation is clinically indicated.","Statement"]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Patients with liver failure plus any other organ dysfunction should be managed in a critical care environment. Attention should be made to cardiovascular support, rapid correction of  actual or relative hypovolaemia, early renal and metabolic support.","met / not met",null,"RECOMMENDATIONS",4.5]
[2,"Sepsis is very common in patients with liver failure and intravenous antibiotics should be prescribed in any patient with a suggestion of sepsis on admission to critical care. The choice of antibiotic will be driven by knowledge of local microbiological flora and resistance patterns.","met / not met",null,"RECOMMENDATIONS",4.5]
[3,"The use of prophylactic blood products and other procoagulants products prior to  interventions should be avoided. In general, patients with liver failure develop a balanced  coagulation disorder. Both pro- and anti-coagulant protein production is reduced.  Viscoelastic tests, such as thrombo-elastography or ROTEM, may help in management. ","met: thromboelastogrpahy available, partially: principles followed but no TE available, unmet",null,"RECOMMENDATIONS",4.5]
[4,"Patients with ALF should have access to plasma exchange therapies.","met  /  not met / not applicable ",null,"RECOMMENDATIONS",4.5]
[5,"Patients with ALF should have access to techniques used to assess intracranial pressure and/or cerebral perfusion, with intracranial hypertension being a recognised complication in patients with ALF. Strategies to monitor and manage ICH should be available in centres managing this group.","met / not met / not applicable",null,"RECOMMENDATIONS",4.5]
[6,"Advice should be sought from a specialist hepatologist for help with diagnosis, specific therapies and prognosis.","met / not met",null,"RECOMMENDATIONS",4.5]
[7,"Centres managing liver failure and liver trauma should have access to interventional radiologists.","met / not met / not applicable",null,"RECOMMENDATIONS",4.5]
[8,"Links should be made with regional centre providing transjugular intrahepatic portosystemic shunt (TIPSS) for patients with bleeding varices.","met / not met",null,"RECOMMENDATIONS",4.5]
[9,"Units that manage patients with liver failure should have 24-hour access to both diagnostic and therapeutic upper GI endoscopy service.","met = both, unmet if not available or no intervention available",null,"RECOMMENDATIONS",4.5]
[10,"Drug dosing may need adjusting in patients with liver failure. Close collaboration with an intensive care pharmacist with suitable experience in liver failure is essential.","met / not met",null,"RECOMMENDATIONS",4.5]
[null,null,null,null,"-"]
[4.5999999999999996,"Cardiovascular Support",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Electrocardiography, chest X-Ray and transthoracic echocardiography (includes focused echo) although expertise may not \tbe in unit and could be provided by other specialty such as cardiology. must be available at all times at the patient’s bedside.","met = all available, partial = echo availability in hospital 24/7 but not always on unit, unmet = no echo available",null,"STANDARDS",4.5999999999999996]
[2,"A consultant cardiologist must be available at all times either locally or through a formal network. ","met / not met",null,"STANDARDS",4.5999999999999996]
[3,"Adults with acute heart failure must be reviewed within 24 hours of admission by a dedicated specialist heart failure team (or equivalent), and their management should follow the guidelines detailed in the NICE Quality Standards.","met / not met",null,"STANDARDS",4.5999999999999996]
[4,"Protocols for immediate transfer to a facility able to provide percutaneous revascularisation of patients presenting a myocardial infarction must be in place.","met / not met",null,"STANDARDS",4.5999999999999996]
[5,"The intensive care team must facilitate the implementation of national standards, guidelines and pathways pertaining to the patients with a cardiac disease, to be delivered in addition to the other organ support being provided.","met / not met",null,"STANDARDS",4.5999999999999996]
[6,"The advanced management of patients with acute valvular insufficiency or acute heart failure secondary to valve disease must be guided in consultation with a local cardiologist and the specialist cardiothoracic surgical unit.","met / not met",null,"STANDARDS",4.5999999999999996]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"A validated method for advanced haemodynamic assessment with a skilled operator in both the practical use of the device and interpreting the data it provides should be available at all times.","met / not met",null,"RECOMMENDATIONS",4.5999999999999996]
[2,"An intra-aortic balloon pump should be available (in consultation with local/regional cardiology team). This may require transfer to another centre.","met / not met",null,"RECOMMENDATIONS",4.5999999999999996]
[3,"Local protocols in the use of vasoactive drugs should be in place, although there is little evidence to support the use of any single agent in practice.","met / not met",null,"RECOMMENDATIONS",4.5999999999999996]
[null,null,null,null,"-"]
[4.7,"Echocardiography and Ultrasound",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"The gold standard investigation is a comprehensive study, performed and reported by a fully trained clinical specialist.","Statement"]
[2,"A more limited study, focusing on a specific clinical question, is appropriate in many instances.  This must be performed by a trained and competent practitioner.","met / not met",null,"STANDARDS",4.7]
[3,"Individuals who scan and report independently must be trained to a level that is appropriate for their clinical practice.  ","met / not met",null,"STANDARDS",4.7]
[4,"The service must have a nominated lead consultant with dedicated time in their job plan that is sufficient to reflect the demands of the service and associated governance processes.","met / not met",null,"STANDARDS",4.7]
[5,"Ultrasound equipment must be readily available, serviced regularly and up to date. There must be sufficient equipment to ensure immediate access for ultrasound guided vascular access at all times. Linear, curvilinear and phased array probes are required to provide a comprehensive ultrasound service.","met= immediate availability (ie on unit) of ultrasound machine for vascular access and rapid access of machine for focused echo/lung ultrasound / partially = not all elements eg only 1 machine on a large unit / not all probe types/ not met",null,"STANDARDS",4.7]
[6,"Infection control measures must be adhered to at all times.","met / not met",null,"STANDARDS",4.7]
[7,"The disinfection and storage of transoesophageal echocardiography probes must follow national guidelines. A record must be retained in order to identify and track patients after device usage in the event of future complication/infection.","met / not met / not applicable ( no TOE) ",null,"STANDARDS",4.7]
[8,"All images must be securely stored for quality assurance purposes with appropriate data governance.  Reliance on the ultrasound machine storage capacity is not a secure method.","met = all images are stored, reviewed by trained echo specialist and uploaded to PACS, partial = uploaded but not reviewed or reviewed but non centralised storage, unmet = images not safely archived in PACS",null,"STANDARDS",4.7]
[9,"Whenever scans are performed to inform clinical decision making, a structured report must be generated and stored in the patient record.","met = structured report and audited, with > 90% compliance, partially met reported but not structured, not audited or < 90% compliance , not met = < 50% reported/documented in notes",null,"STANDARDS",4.7]
[10,"Training scan reports must not be stored in the patient record unless someone suitably trained verifies the document first.","met / not met",null,"STANDARDS",4.7]
[11,"Quality improvement, audit, and peer review activity must occur regularly.","Fully met = peer review process at least monthly, partially met = peer review less frequently, not met = no regular system of peer review   (excludes ad hoc peer review)",null,"STANDARDS",4.7]
[12,"Transoesophageal echocardiography (TOE) must be immediately available in all cardiothoracic critical care units and those units providing extra-corporeal circulatory support.","met / not met / not applicable ( no TOE) ",null,"STANDARDS",4.7]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"All critical care units should be able to ensure the provision of point-of-care ultrasound. ","met / not met",null,"RECOMMENDATIONS",4.7]
[2,"The service should be supported by a fully trained link-person within the cardiology and radiology departments, as appropriate.","met / not met",null,"RECOMMENDATIONS",4.7]
[3,"Individuals who participate should regularly attend their institutional ultrasound meetings.","met / not met",null,"RECOMMENDATIONS",4.7]
[4,"Individuals who scan and report independently should keep a personal logbook of their images and reports.","met / not met",null,"RECOMMENDATIONS",4.7]
[5,"Individuals should not report scans beyond their level of accreditation, but should participate in a training programme, leading to more advanced accreditation. ","met / not met",null,"RECOMMENDATIONS",4.7]
[6,"Images and reports should be uploaded together to the same archive used by the host institution’s cardiology or radiology department, as appropriate.  Reports should identify the focused nature of the investigation and the clinical context. Scans undertaken as part of training should not be archived before they have been verified by a trainer.","met / not met",null,"RECOMMENDATIONS",4.7]
[7,"Regional networks and electronic image transfer systems should be created to allow for prompt access to review scans by a specialist with Level 2 accreditation, or equivalent, when this is required.","met / unmet ",null,"RECOMMENDATIONS",4.7]
[8,"Consideration should be given to the development of fully qualified physiologists with dedicated intensive care commitment and experience under joint supervision to deliver echocardiography services within intensive care.","met / not met / not applicable ",null,"RECOMMENDATIONS",4.7]
[9,"Regular replacement of ultrasound equipment is required to ensure it remains up to date. Normal guidance states that electrical equipment is replaced every seven years, however ultrasound equipment may need to be updated more frequently to keep up with technological advances.","met / not met",null,"RECOMMENDATIONS",4.7]
[null,null,null,null,"-"]
[4.8,"Neurological Support",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Adult patients with refractory convulsive status epilepticus must be admitted to critical care and have EEG monitoring established; the primary endpoint of treatment being the suppression of epileptic activity on EEG.","met - continuous EEG or processed EEG available on unit, not met, no EEG / Processed EEG available",null,"STANDARDS",4.8]
[2,"Adults who are unconscious after (out of hospital) cardiac arrest caused by suspected acute ST segment elevation myocardial infarction must be considered for coronary angiography with follow-on primary percutaneous coronary intervention if indicated.","met / not met",null,"STANDARDS",4.8]
[3,"Following traumatic spinal cord injury, a specialist neurosurgical or spinal surgeon at the major trauma centre or trauma unit must contact the linked spinal cord injury centre consultant within four hours of diagnosis to establish a partnership of care.","met / not met",null,"STANDARDS",4.8]
[4,"Previously fit adults, admitted to critical care following a primary intracerebral haemorrhage, must be referred to specialist neurosurgical centres for consideration of surgical evacuation.","met / not met",null,"STANDARDS",4.8]
[5,"Adults under the age of 60 with middle cerebral artery infarction admitted to intensive must have access to a decompressive craniectomy service at a specialist neurosciences centre.","met / not met",null,"STANDARDS",4.8]
[6,"Declaration of death by neurological criteria must be conducted as per the Academy of Medical Royal College’s Code of Practice.","met / not met",null,"STANDARDS",4.8]
[7,"Prognostication in hypoxic-ischaemic brain injury after resuscitation from cardiac arrest should follow the European Advisory Statement on Neurological Prognostication in comatose survivors of cardiac arrest.","met - able to fully follow partially met - able to undertake some additional testing beyond CT, unmet - unable to meet any additional investigations ",null,"STANDARDS",4.8]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Protocols should be available to deliver post-resuscitation care to comatose survivors following cardiac arrest as per the Resuscitation Council (UK) guidelines.","met / not met ",null,"RECOMMENDATIONS",4.8]
[2,"The management of traumatic brain injury should follow national and international best practice guidance.","met / not met ",null,"RECOMMENDATIONS",4.8]
[3,"Management of patients with prolonged disorders of consciousness should follow national guidance.","met / not met ",null,"RECOMMENDATIONS",4.8]
[4,"Patients with perceived devastating brain injury should be admitted to the critical care unit to aid prognostication as per national guidance.","met / not met ",null,"RECOMMENDATIONS",4.8]
[5,"Intracerebral haemorrhage should be managed in accordance with international guidance with particular attention to the reversal of anticoagulation and acute control of blood pressure.","met / not met ",null,"RECOMMENDATIONS",4.8]
[6,"The management of suspected viral encephalitis or acute meningitis in adults should follow national guidance.","met / not met ",null,"RECOMMENDATIONS",4.8]
[7,"The management of patients with ventilatory insufficiency due to neuromuscular disease should follow BTS/ICS guidelines.","met / not met ",null,"RECOMMENDATIONS",4.8]
[8,"The management of decompensated acute inflammatory neuropathy should follow best practice guidance.","met / not met ",null,"RECOMMENDATIONS",4.8]
[9,"Autoimmune encephalitis should be suspected and investigated in all adults presenting with the internationally described criteria proposed to identify this disease.","met / not met ",null,"RECOMMENDATIONS",4.8]
[10,"Adults admitted with an acute neurological problem should have access to daily consultation or advice from neurology specialists, if necessary by telemedicine.","met - as per recomendation, partially met - less frequently than daily consultation, no telemedicine, unmet - difficult to access neurology advice ",null,"RECOMMENDATIONS",4.8]
[11,"Critical care units caring for patients with neurological pathology should have agreed venous thromboembolism (VTE) policies that balance the risk of recurrent haemorrhage with the need to provide prophylaxis against VTE.","met / not met ",null,"RECOMMENDATIONS",4.8]
[12,"Fever control to normothermia following traumatic brain injury, aneurysmal subarachnoid haemorrhage, ischaemic stroke, or haemorrhagic stroke may improve outcome.","a temperature controling device with a closed feedback loop must be available met / not met",null,"RECOMMENDATIONS",4.8]
[13,"Appropriate patients with acute ischaemic stroke should be referred for mechanical thrombectomy in accordance with national commissioning policy.","met - referal pathway in place 24/7 partially met - referral pathway les than 24/7, unmet - no referral pathway ",null,"RECOMMENDATIONS",4.8]
[null,null,null,null,"-"]
[4.9000000000000004,"Burns",null,null,"-"]
[null,"Burns units only ",null,null,"-"]
[]
["STANDARDS",null,null,null,"-"]
[1,"Staffing models must promote joint care between burn and critical care teams as this may improve safety and confer a significant survival benefit.","met / not met",null,"STANDARDS",4.9000000000000004]
[2,"A burns theatre must be located in immediate proximity (preferably within 50 metres) to any service providing critical care for burn injured patients.","met / not met",null,"STANDARDS",4.9000000000000004]
[3,"Burn injured patients who require critical care must be managed by consultants in Intensive Care Medicine who have an appropriate level of training in this field and have acquired the relevant knowledge and skills needed to care for these patients.","met / not met",null,"STANDARDS",4.9000000000000004]
[4,"Burn injured patients must be cared for in an appropriate service as determined by the National Burn Care Referral Guidance.","met / not met",null,"STANDARDS",4.9000000000000004]
[5,"Transfer of critically ill burn patients between services must comply with Intensive Care Society guidelines.","met / not met",null,"STANDARDS",4.9000000000000004]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"All burns over 20% total body surface area (TBSA) should have access to thermally controlled single-bedded cubicles.","met / not met ",null,"RECOMMENDATIONS",4.9000000000000004]
[2,"Fibre-optic bronchoscopy should be used to assess inhalation injury.","met / not met ",null,"RECOMMENDATIONS",4.9000000000000004]
[3,"Services providing centre level care should be co-located with a major trauma centre. Where this is not the case, mechanisms for ensuring appropriate integration with trauma centre care should be in place.","met / not met ",null,"RECOMMENDATIONS",4.9000000000000004]
[4,"In specialist centres, clinical guidelines should include: a) Fluid resuscitation and management of associated complications, b) Assessment and management of burns to the face and airway, c) Management of smoke inhalation injury and its sequelae, including carbon monoxide and cyanide poisoning, d) Recognition and management of the acutely unwell and deteriorating burn injured patient, including burn specific criteria for the diagnosis of sepsis, e) Management of hypothermia and hyperpyrexia, f) Management of burn wound infections including antimicrobial stewardship, g) Nutritional assessment, h) Rehabilitation. These guidelines should be subject to periodic review and update.","met - all guidelines and reviewed within 3 years, partially met - one / two missing guidelines or not reviewed within 3 years, not met - more than two missing or not reviewed within 3 years ",null,"RECOMMENDATIONS",4.9000000000000004]
[5,"The implementation of end of life care as a result of burn injury should only be made following assessment by at least two consultants, one of whom should be a specialised burn care surgeon.","met / not met ",null,"RECOMMENDATIONS",4.9000000000000004]
[6,"There should be a nominated lead consultant for burns, who participates in network and national morbidity and mortality audit meetings.","met / not met ",null,"RECOMMENDATIONS",4.9000000000000004]
[null,null,null,null,"-"]
[4.0999999999999996,"Care of the Critically Ill Pregnant (or Recently Pregnant) Woman",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Any critical care unit that admits antenatal women over 20 weeks’ gestation must have rapid access to obstetric and paediatric services able to attend in an emergency.  There must be a clear plan and equipment immediately available for performing a peri-mortem caesarean section in the event of maternal cardiac arrest, with appropriate neonatal resuscitation equipment.","met / not met ",null,"STANDARDS",4.101]
[2,"An obstetric team (normally a consultant obstetrician, a consultant obstetric anaesthetist and a midwife) must review all pregnant women admitted to critical care at least once in every twenty-four hour period.","met - as per standard, partially met - less frequent, unmet - difficult to achieve ",null,"STANDARDS",4.101]
[3,"In antenatal ICU admissions, when fetal viability is a possibility, a health care professional trained in neonatal resuscitation must be available within 10 minutes and a senior neonatologist or paediatrician must be able to attend within 30 minutes.","met / not met ",null,"STANDARDS",4.101]
[4,"All critical care units that admit pregnant or recently pregnant women must have a named lead clinician for maternal critical care (MCC). The main function of this role is to be the point of liaison between critical care and obstetric services (including obstetric anaesthesia).","met / not met ",null,"STANDARDS",4.101]
[5,"Breast feeding (including the use of breast pumps) must be encouraged and supported in all post-natal women admitted to critical care.","met / not met ",null,"STANDARDS",4.101]
[6,"Women who require care that falls outside Enhanced Maternal Care (EMC) must be referred as soon as possible to the general critical care service. The route of escalation to critical care services must be clearly defined.","met / not met ",null,"STANDARDS",4.101]
[7,"Critical care outreach or equivalent must be available and provide clinical support and education into EMC.","met / not met ",null,"STANDARDS",4.101]
[8,"Critically ill pregnant or recently pregnant women who undergo intra- or inter-facility transfer must be transferred in accordance with standards equivalent to the Intensive Care Society’s Guidelines for the transport of the critically ill adult","met / not met ",null,"STANDARDS",4.101]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Level 3 antenatal ICU admissions and post-natal admissions that are anticipated to last more than 48 hours should be considered for transfer to a regional or supra-regional critical care unit with experience in MCC.","met / not met ",null,"RECOMMENDATIONS",4.101]
[2,"Physical contact between a mother and her baby should be maintained during post-natal critical illness, even if the mother is unconscious.  This contact and other events of the admission should be recorded in a critical care diary which can be used in psychological rehabilitation after critical care or in bereavement counseling.","met / not met",null,"RECOMMENDATIONS",4.101]
[3,"All women admitted to critical care should be offered an appointment in a critical care follow-up clinic or a post-natal review, which includes input from a clinician with experience in critical care follow-up.","met / not met",null,"RECOMMENDATIONS",4.101]
[4,"Recognition of EMC should be incorporated into midwifery pre & post registration curricula and feature in obstetric, anaesthetic and critical care training programmes.","Statement"]
[5,"Healthcare professionals looking after critically ill women should undergo regular, cross-specialty, multidisciplinary team training, to encourage sharing of knowledge and skills and to promote teamwork and effective communication.","met / not met",null,"RECOMMENDATIONS",4.101]
[6,"Simulation-based learning should be considered to assist healthcare professionals to develop the technical and non-technical skills for EMC.","met / not met",null,"RECOMMENDATIONS",4.101]
[7,"Critical care networks should consider nominating specific units as the nominated regional or supra-regional unit for MCC.","met / not met",null,"RECOMMENDATIONS",4.101]
[8,"Obstetric units delivering EMC or level 2 critical care should be members of a regional MCC network which itself should have a formal relationship with the local Critical Care Operational Delivery Network and Strategic Clinical Networks.","met / not met",null,"RECOMMENDATIONS",4.101]
[9,"MCC quality indicators should be monitored, using data reported through the ICNARC Case Mix Programme and the Scottish Intensive Care Society Audit Group and used to improve local performance.","met / not met",null,"RECOMMENDATIONS",4.101]
[null,null,null,null,"-"]
[4.1100000000000003,"Care of the Critically Ill Child in an Adult Critical Care Unit",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Critically ill children under 16 years old must only be admitted to and stay on an adult critical care unit if a PICU bed is unavailable, or when there is an expected short duration of critical care e.g. an older child with overdose or alcohol excess.","met / not met",null,"STANDARDS",4.1100000000000003]
[2,"Admission must be discussed and agreed by the local consultant in Intensive Care Medicine, local consultant paediatrician and the consultant in paediatric Intensive Care Medicine (this may be the regional paediatric transport team consultant).","met / not met",null,"STANDARDS",4.1100000000000003]
[3,"A nominated lead intensive care consultant and lead nurse in the adult critical care unit must be responsible for intensive care policies, procedures and training related to the care of children.","met / not met",null,"STANDARDS",4.1100000000000003]
[4,"An adult critical care unit that may provide care for critically ill children must have an appropriately equipped area for providing paediatric critical care.","met / not met",null,"STANDARDS",4.1100000000000003]
[5,"Medical staff with responsibility for the resuscitation and airway management of the critically ill child on an adult unit must have up-to-date competencies in advanced paediatric life support and advanced airway management. This medical cover may be provided by anaesthetists or consultants in Intensive Care Medicine according to local arrangements.","met / not met",null,"STANDARDS",4.1100000000000003]
[6,"Protocols for resuscitation, stabilisation, accessing advice, maintenance and transfer of critically ill children and the provision of paediatric critical care must be available.","met / not met",null,"STANDARDS",4.1100000000000003]
[7,"Escalation, end of life and organ donation decisions must be discussed in collaboration with the regional consultant in paediatric intensive care (this may be the regional paediatric transport team consultant), under a shared care and shared responsibility model.","met / not met",null,"STANDARDS",4.1100000000000003]
[8,"There must be collaborative working between the adult critical care unit and the regional PICU to ensure that staff are supported to work outside their normal core competencies. There must be 24/7 access to paediatric medical and paediatric nursing advice.","met - as per standard, partially met - no formal arrangement, unmet - not anticipated to happen ",null,"STANDARDS",4.1100000000000003]
[9,"A local consultant paediatrician and consultant in paediatric Intensive Care Medicine must be available for advice at all times.","met / not met",null,"STANDARDS",4.1100000000000003]
[10,"There must be 24-hour access for parents/carers to visit their child.","met / not met",null,"STANDARDS",4.1100000000000003]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"A registered paediatric nurse should be available at all times to support the care of the child.","met / not met ",null,"RECOMMENDATIONS",4.1100000000000003]
[2,"The child should be reviewed by a consultant paediatrician twice a day during their stay on the adult unit.","met - as per standard, partially met - visited as requested / required , unmet unlikely to acheive standard",null,"RECOMMENDATIONS",4.1100000000000003]
[3,"There should be access to specialist paediatric healthcare professional and pharmacy advice at all times.","met - as per standard, partially met - visited as requested / required , unmet unlikely to acheive standard",null,"RECOMMENDATIONS",4.1100000000000003]
[null,null,null,null,"-"]
[4.12,"Standardised Care of the Critically Ill Patient",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Patients must be assessed daily for risk of thromboembolic disease and receive appropriate prophylaxis.","met = guideline and audit data to show compliance  > 90%, partially met = guideline but no audit or compliance < 90%, un met = no guideline or compliance < 50%",null,"STANDARDS",4.12]
[2,"Patients undergoing controlled mechanical ventilation must receive tidal volumes based on predicted body weight (PBW). Patients with ARDS must receive a tidal volume of less than or equal to 6 ml/kg PBW.","met = guideline and audit data to show compliance  > 90%, partially met = guideline but no audit or compliance < 90%, un met = no guideline or compliance < 50%",null,"STANDARDS",4.12]
[3,"Ventilated patients must have respiratory function evaluated daily and undergo spontaneous breathing trials where appropriate.","met / not met - no SBTs ",null,"STANDARDS",4.12]
[4,"Sedation must be individualised to patient needs and the appropriateness of a sedation hold considered daily.","met / not met",null,"STANDARDS",4.12]
[5,"All patients must be assessed regularly for evidence of pain, with analgesia optimised to minimise sedation requirements.","met / not met",null,"STANDARDS",4.12]
[6,"All patients must be screened daily for evidence of delirium using a validated method such as the Confusion Assessment Method for the ICU (CAM-ICU) or the Intensive Care Delirium Screening Checklist (ICDSC).","met / not met",null,"STANDARDS",4.12]
[7,"Indwelling intravascular catheters must be inspected daily for evidence of infection using a suitable scoring system e.g. Visual Infusion Phlebitis Score (Jackson 1998) to guide necessity for removal.","met = guideline and audit data to show compliance  > 90%, partially met = guideline but no audit or compliance < 90%, un met = no guideline or compliance < 50%",null,"STANDARDS",4.12]
[8,"The continued need for indwelling catheters (intravascular or urinary) must be considered daily.","met = guideline and audit data to show compliance  > 90%, partially met = guideline but no audit or compliance < 90%, un met = no guideline or compliance < 50%",null,"STANDARDS",4.12]
[9,"Monitoring of invasively ventilated patients must include continuous waveform capnography.","met / not met",null,"STANDARDS",4.12]
[10,"Care bundles must be in place for Intubation Associated Pneumonia (IAP) prevention, Central Venous Catheter (CVC) insertion and maintenance, and Peripheral Venous Cannula (PVC) insertion and maintenance.","met / not met",null,"STANDARDS",4.12]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"For patients without ARDS, a tidal volume of 4-8 mls/kg PBW and a peak/plateau pressure (depending on mode) of below 30 cmH20 should be targeted.","met = guideline and audit data to show compliance  > 90%, partially met = guideline but no audit or compliance < 90%, un met = no guideline or compliance < 50%",null,"RECOMMENDATIONS",4.12]
[2,"A ventilated patient care bundle should be in place with appropriate mechanisms for ensuring adherence.","met / not met",null,"RECOMMENDATIONS",4.12]
[3,"Ventilated patients should receive H2 receptor blockade (e.g. ranitidine) or a proton pump inhibitor for gastric protection until established on full enteral nutrition.","met / not met",null,"RECOMMENDATIONS",4.12]
[4,"Unless clinically contra-indicated, ventilated patients should be nursed in a semi-recumbent position at 30 to 45 degrees.","met / not met",null,"RECOMMENDATIONS",4.12]
[5,"Where there is no contraindication, enteral nutrition (EN) should be initiated within 48 hours after admission to the ICU.","met / not met",null,"RECOMMENDATIONS",4.12]
[6,"When EN is not feasible or insufficient, parenteral nutrition should be started as soon as possible in patients with (or at high risk of) malnutrition, (which maybe a combination of cachexia (disease related) and malnutrition (inadequate consumption of nutrients)).","met / not met",null,"RECOMMENDATIONS",4.12]
[7,"All sedated patients should have sedation levels monitored hourly using a scoring system such as the Riker Sedation–Agitation Scale or the Richmond Agitation–Sedation Scale to ensure sedation is minimised.","met = guideline and audit data to show compliance  > 90%, partially met = guideline but no audit or compliance < 90%, un met = no guideline or compliance < 50%",null,"RECOMMENDATIONS",4.12]
[8,"Noise levels and patient interventions should be minimised overnight to facilitate natural sleep.","met / not met",null,"RECOMMENDATIONS",4.12]
[9,"A transfusion threshold of 70g/L should be used in general intensive care patients. A higher target Hb may be beneficial in patients with sepsis (in the first six hours), ischaemic stroke, traumatic brain injury with cerebral ischaemia, or acute coronary syndromes.","met = guideline and audit data to show compliance  > 90%, partially met = guideline but no audit or compliance < 90%, un met = no guideline or compliance < 50%",null,"RECOMMENDATIONS",4.12]
[10,"Critical care units should consider standardisation of drug concentrations in line with FICM/ICS guidance.","met / not met ",null,"RECOMMENDATIONS",4.12]

{"sheet":"Additional Components","index":7,"n_rows":90,"n_cols":7,"rows_kept":90,"cut":false,"hidden":false,"merged":[]}
["Section 5","CRITICAL CARE SERVICES: ADDITIONAL COMPONENTS","Level description","Level","Hidden","Hidden","Comments"]
[null,null,null,null,"-"]
[5.0999999999999996,"Research and Development",null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"All individuals participating in R&D activity must have completed Good Clinical Practice (GCP) training for research and keep this up to date.","met / not met",null,"STANDARDS",5.0999999999999996]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Critical care units should nominate a lead for R&D activities who should coordinate activity and ensure it is carried out to UK Policy Framework for Research standards.","met / not met or not applicable ",null,"RECOMMENDATIONS",5.0999999999999996]
[2,"Critical care units should participate in research networks, which are organised at Local Clinical Research Network (LCRN) level through the regional National Institute of Healthcare Research (NIHR) Critical Care research network lead.","met / not met or not applicable ",null,"RECOMMENDATIONS",5.0999999999999996]
[3,"All research studies should be registered on the UK Critical Care Research Portfolio whenever they fulfil eligibility criteria.","met / not met or not applicable ",null,"RECOMMENDATIONS",5.0999999999999996]
[4,"Critical care units participating in research should provide information to patients, relatives, and surrogate decision-makers (SDMs) about ongoing research, for example through posters, leaflets, or within generic intensive care information resources.","met /  not met or not applicable ",null,"RECOMMENDATIONS",5.0999999999999996]
[5,"Critical care units participating in research should have clear procedures for approaching patients, families and SDMs in a manner that minimises stress, but provides adequate information in a timely manner. ","met /  not met or not applicable ",null,"RECOMMENDATIONS",5.0999999999999996]
[6,"Critical care units participating in multiple research studies should have clear co-enrolment policies based on the UK co-enrolment guideline.","met / not met or not applicable ",null,"RECOMMENDATIONS",5.0999999999999996]
[null,null,null,null,"-"]
[5.2,"Audit and Quality Improvement",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Critical care units must have a structured and planned clinical audit programme to compare practice to published standards. There must be an identified lead for the audit programme.","met / not met",null,"STANDARDS",5.2]
[2,"Critical care units must participate in a National Audit Programme for Adult Critical Care, such as the Scottish Intensive Care Society Audit Group (SICSAG) or Intensive Care National Audit and Research Centre (ICNARC) programmes.","met / not met",null,"STANDARDS",5.2]
[3,"Critical care units must have a surveillance system in place for audit and feedback of nosocomial infection, for example, catheter-related bacteraemia and other blood stream infections, reported to the national scheme where applicable. Critical care units should also report the incidence of intubation-associated pneumonia. All units must participate in national audit programmes for nosocomial infections in intensive care, for example, Public Health England Infections in Critical Care Programme (ICCQIP) and Scottish nosocomial infections in ICU audit programme.","met / not met",null,"STANDARDS",5.2]
[4,"Critical care units must measure night-time discharges in order to encourage and support local improvement to reduce night-time intensive care discharges.","Discharges after 21:59 as percentage of all eligible admisisons  - met <2% partially met, 2-4% not met>4%",null,"STANDARDS",5.2]
[5,"Critical care units must obtain regular feedback about the care that patients and relatives receive during their critical care admission in order to learn from and act on the feedback received.","met - annual process, partially met, undertaken every 1-2 years, unmet, never done or less than 2 yearly ",null,"STANDARDS",5.2]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Units should have nominated medical and nursing leads for quality improvement and audit. Appropriate time should be made available in job plans for these duties. Time to participate in audit and quality improvement programmes should also form part of the job plans of all intensive care staff (medical, nursing, pharmacists, healthcare professionals and ancillary staff).","met/ unmet",null,"RECOMMENDATIONS",5.2]
[2,"Hospitals should have a quality improvement (QI) programme in place for each critical care unit in their organisation. The programme should aim to deliver safe, efficient, effective, patient-centred, timely and equitable patient care, which is evidence based, and should follow recognised quality improvement methodology.","met / unmet",null,"RECOMMENDATIONS",5.2]
[3,"Staff should be encouraged and supported to train in quality improvement methodology and all projects should be multidisciplinary, recognising the necessity for a team approach and the contribution of all staff groups.","met / unmet",null,"RECOMMENDATIONS",5.2]
[4,"Audits should be linked to QI programmes. Units should have robust data-collection systems in place that support the collection of activity and quality data for local and national audit programmes.","met - robust data collection and feedback for both local and national audit, partially met - robust data collection and feedback for national audit only, not met - no robust systems for data collection or feedback, ",null,"RECOMMENDATIONS",5.2]
[5,"Critical Care Networks should have a formal, multi-professional, peer-review programme in place for the units in their jurisdiction. Peer reviews should be based on published national standards, but are likely to include other areas that are agreed locally.","met / not met / not applicable",null,"RECOMMENDATIONS",5.2]
[6,"All critical care units must measure and report their delayed discharge, out of hours discharges, non-clinical transfers and readmissions within 48 hours of discharge, as a potential indicator of resource pressures. It is recommended that units should also measure early discharges as they may be a marker of insufficient resources.","Met - submit all data to  ICNARC / SICSAG data tools, patially met - one or more data submissions missing , not met - poor data compliance with ICNARC / SICSAG ",null,"RECOMMENDATIONS",5.2]
[null,null,null,null,"-"]
[5.3,"Clinical Governance",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"There must be an appropriately trained consultant and senior nurse identified as leads for clinical governance. The consultant must not be the clinical lead or clinical director for critical care.","met / not met",null,"STANDARDS",5.3]
[2,"There must be a robust system in place for reporting, investigating, and learning from all patient safety incidents. Appropriate action plans must be formulated in response to incidents. Units should also learn from things that go well, a process described in excellence reporting.","met / not met",null,"STANDARDS",5.3]
[3,"Units must hold regular structured multidisciplinary clinical governance meetings, where they discuss unit morbidity and mortality, including all deaths, critical incidents and near misses. A written record of actions taken and lessons learnt should be kept and a timely and reliable method for dissemination of shared learning should be in place. There should be clear structures in place for disseminating findings to staff, and deficiencies in care should lead to measurable change.","met - meets full standard with minimum of quarterly meetings, partially met - meets standard but less than quarterly, unmet - doesnt meet the standards ",null,"STANDARDS",5.3]
[4,"Regular feedback must be obtained from service users and staff about the quality of care delivered, for example by the use of safety surveys and relatives’ questionnaires.","met = undertake critical care led staff safety and relative surveys at least once a year, partially met is less frequently or only one group surveyed. Not met = no patient or staff survey",null,"STANDARDS",5.3]
[5,"Critical care units must participate in a mortality review programme using appropriate methodology to maximise learning and improvements in care. Appropriate actions must be taken whenever preventable factors are found.","met = mortality review process that includes all deaths in ICU. / not met",null,"STANDARDS",5.3]
[6,"All units must maintain a risk register that is regularly reviewed and updated by both senior managerial and clinical staff.","met - in place, quarterly review, partially met, in place less than quarterly review, unmet - not in place ",null,"STANDARDS",5.3]
[7,"The unit must have processes to ensure clinical staff are aware, in a timely fashion, of key learning points from national safety alerts and local learning (for example from patient safety incidents, excellence reports, patient concerns and compliments). Staff must also be able to easily access important information to inform patient care (for example information about medications and unit policies) whenever needed.","met / not met",null,"STANDARDS",5.3]
[8,"Staff who have to conduct reviews of patient safety incidents, root cause analysis and appreciative enquiry must be trained in the management of these processes so that the reviews are conducted sensitively and constructively. Similarly, effective quality improvement requires staff that are trained in quality improvement methodology.","met / not met",null,"STANDARDS",5.3]
[9,"Each unit must have local safety standards for invasive procedures (including tracheostomy, bronchoscopy, central line and chest drain insertion and lumbar puncture). They must also have safe standards for the handover of information for patients going to have invasive procedures in other departments. These standards should include documentation of invasive procedures, handovers and information transfer, procedural verification, a safety briefing and time out, and a sign out and debriefing. An example of this process is the NHS England Safety standards for invasive procedures.","met / not met",null,"STANDARDS",5.3]
[10,"Critical care units must comply with reviews and visits by national organisations, (for example the CQC in England).","met / not met",null,"STANDARDS",5.3]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Intensive care staff should work with other clinical teams in the hospital with respect to joint learning from morbidity and mortality review and ensuring best practice around handovers of care.","met - done quarterly, partially met, done annually, not met, not done - use comments box ",null,"RECOMMENDATIONS",5.3]
[2,"Units should regularly review guidelines from professional organisations and other sources of evidence to ensure that the unit complies with best practice. These evidence sources should be translated into comprehensive locally agreed guidelines or Standard Operating Procedures.","met - annual review, partially met, 1-2 yearly review, not met - less than 2 yearly / not reviewed",null,"RECOMMENDATIONS",5.3]
[3,"The unit should identify key performance indicators (KPIs) that describe outcomes of their service. Such KPIs may be generic and common to most units, such as complication rates, e.g. delirium rates, pain scores or pressure sores. Alternatively, these may be unit specific, for example rates of emergency thoracotomy on cardiac critical care units.","met / not met",null,"RECOMMENDATIONS",5.3]
[4,"Staff should be recognised as the key resource in intensive care. A fully engaged, well-motivated well-trained and well-led workforce is essential to allow excellence in clinical care to flourish. Staff sickness rates, turnover rates and information from appraisal, staff feedback and exit interviews should all be monitored to ensure staff welfare.","Met = all staff wellbeing criteria stated are monitored, partially met = some criteria are monitored, not   met = none of criteria are monitored.",null,"RECOMMENDATIONS",5.3]
[5,"Units should work with other units within their network, and nationally, to share learning, disseminate best practice, quality improvement and for benchmarking and peer review purposes. The governance of critical care units is rightly audited by outside agencies, including intensive care networks. The external responsibility for the oversight of governance arrangements varies between the devolved nations.","met = Units participate in Network led program to share best practice and QI’/  not met ",null,"RECOMMENDATIONS",5.3]
[6,"The unit should be able to demonstrate that it is continuously working to improve patient care using recognised quality improvement techniques delivered by appropriately trained staff.","met= Unit have undertaken at least one local patient centric QI program in previous 12 months / unmet ",null,"RECOMMENDATIONS",5.3]
[null,null,null,null,"-"]
[5.4,"Critical Care Networks",null,null,"-"]
[null,"*These may not be applicable for countries which do not have networks",null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Critical care ODNs must support the activity of provider healthcare organisations in service redesign and delivery of the commissioned pathway, quality improvements, innovation and standardisation of clinical practice. They provide a mechanism for peer review and benchmarking self-assessment in the network.","met / not met / not applicable",null,"STANDARDS",5.4]
[2,"Critical care ODNs must support commissioners in the delivery of their commissioning functions, through creating and delivering innovation, quality improvements and efficiency across the pathway, and developing, devising and supporting local strategies for adult critical care services across the geographical footprint, including advice on improvement.","met / not met / not applicable",null,"STANDARDS",5.4]
[3,"Critical care ODNs must support delivery of a resilient critical care service within a geographical area to meet emergency preparedness requirements.","met / not met / not applicable",null,"STANDARDS",5.4]
[4,"Each provider of adult critical care must engage, contribute and participate in activities of their local critical care ODN and will contribute to the funding of their local ODN through a nationally agreed mechanism; this is currently a 0.1% CQUIN top slice, but may be supplemented by local agreements made in conjunction with key stakeholders through the ODN Executive/Oversight Group/Board.","met / not met / not applicable",null,"STANDARDS",5.4]
[5,"The intensive care team in provider organisations must engage, contribute and participate in a critical care ODN, including audit activity, peer review and quality improvement processes.","met / not met / not applicable",null,"STANDARDS",5.4]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"ODNs should take a whole-system, collaborative-provision approach to facilitate the delivery of safe and effective services across the patient pathway, with an emphasis on the quality and equity of access to service provision.","met / not met / not applicable",null,"RECOMMENDATIONS",5.4]
[2,"ODNs should aid cross-organisational, multi-professional clinical engagement for the sharing of best practice and knowledge. They should both identify and implement improvements to enhance patient care, enabling the design of effective clinical flows and pathways of care for networked provision of services. This will allow for more local determination, innovation and efficiency across the pathway.","met / not met / not applicable",null,"RECOMMENDATIONS",5.4]
[3,"ODNs should focus on quality and effectiveness through facilitation of comparative benchmarking and auditing of services, with implementation of required improvements. This should span the wider hospital system, to include dedicated critical care units, as well as resources to support acutely unwell patients on general wards. This includes rehabilitation of patients recovering from critical care in hospital and in the community.","met / not met / not applicable",null,"RECOMMENDATIONS",5.4]
[4,"ODNs should create an operational model that allows effective work programmes for the delivery of local and regional priorities, service specification standards, national programme of care outcomes and outcome framework targets.","met / not met / not applicable",null,"RECOMMENDATIONS",5.4]
[5,"ODNs should have robust governance arrangements that ensure functionality, working with both providers and commissioners, to enable the development of improved service standards to continually enhance the patient, family and carer experience.","met / not met / not applicable",null,"RECOMMENDATIONS",5.4]
[6,"ODNs should have a core management team capable of delivering the work of the network according to local requirement. They should provide clinical and executive management/leadership to support the delivery of established network plans, enabling action in response to adverse situations or outlying practices. As a minimum, this would include senior management, lead medical and nursing roles and administrative support. These roles are independent of both the host organisation and the substantive employer (where this is not the host).","met / not met / not applicable",null,"RECOMMENDATIONS",5.4]
[7,"Each participating member organisation should ensure appropriate representation at critical care ODN meetings, task groups and other forums in accordance with the network’s terms of reference. Through the baseline contract agreement (local or national), member organisations should comply with ODN standards, policies and guidelines.","met / not met / not applicable",null,"RECOMMENDATIONS",5.4]
[8,"Each adult critical care provider should adhere to requirements to measure and evaluate quality indicators and service delivery, in line with the national Adult Critical Care Service Specification (D05). This specification may be supplemented by additional requirements by the local ODN (for example GPICS V2 standards and recommendations). Such supplemental standards should be approved by the ODN through their local governance structure.","met / not met / not applicable",null,"RECOMMENDATIONS",5.4]
[9,"ODNs should provide leadership support in network-wide emergency preparedness, have a role in clinical contingency planning and respond to increased demand through national, regional and local determination. ODNs should act on identified challenges as they emerge, e.g. a local critical care bed crisis or large-scale major incidents.","met / not met / not applicable",null,"RECOMMENDATIONS",5.4]
[10,"ODNs should encourage the positive engagement of adult critical care providers in their networks and support critical care units in developing their service to its maximum potential by implementing the recommendations outlined above.","met / not met / not applicable",null,"RECOMMENDATIONS",5.4]
[null,null,null,null,"-"]
[5.5,"Critical Care Commissioning",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"All units must comply with national commissioning arrangements in place in England, Wales, Scotland and Northern Ireland.","met / not met",null,"STANDARDS",5.5]
[2,"CCMDS must be collected and reported in all designated Adult Critical Care locations in England.","met / not met  / NA ",null,"STANDARDS",5.5]
[3,"Data collection must commence from the date and time that the patient first occupies a designated critical care bed or, if in a non-designated critical care location (theatre recovery/ward), data entry should only occur when a patient has received critical care for a period of time in excess of four hours. The care received by patients in these non-designated areas must include clinical interventions, monitoring and continuous supervision normally associated with a critical care area.","Met = data is collected on critical care episodes delivered outside of designated critical care area / not met",null,"STANDARDS",5.5]
[4,"Adult critical care reference cost submissions must assign costs to individual HRGs.","Statement"]
[5,"All providers in England, Wales and Northern Ireland with adult critical care services must be members of a Critical Care Operational Delivery Network.","met / not met",null,"STANDARDS",5.5]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[null,"These recommendations may not be applicable to those units outside of England and Wales"]
[1,"Collection of all 34 fields in CCMDS is recommended. This should be done by dedicated trained personnel.","met / not met",null,"RECOMMENDATIONS",5.5]
[2,"There should be clinical oversight of the CCMDS data entry/data submission to ensure accuracy of data.","met / not met",null,"RECOMMENDATIONS",5.5]
[3,"Preparation of reference costs should include experienced clinician involvement.","met / not met",null,"RECOMMENDATIONS",5.5]
[4,"Agreement should be in place to support early notification to a patient’s CCG for longer-stay patients who are likely to have complex home needs, such as home ventilation to aid discharge planning including the identification of a funding package.","met / not met",null,"RECOMMENDATIONS",5.5]
[5,"A lead commissioner should be identified with a commissioning forum for each critical care service.","met / not met",null,"RECOMMENDATIONS",5.5]

{"sheet":"Emergency Preparedness","index":8,"n_rows":75,"n_cols":7,"rows_kept":75,"cut":false,"hidden":false,"merged":[]}
["Section 6","CRITICAL CARE SERVICES: EMERGENCY PREPAREDNESS","Level description","Level","Hidden","Hidden","Comments"]
[null,null,null,null,"-"]
[6.1,"Fire",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"All units must have well marked fire call points, fire extinguishers and oxygen shut-off valves.","Met or unmet",null,"STANDARDS",6.1]
[2,"Each unit must have a specific fire evacuation policy in place, which takes account of: a) the layout of the building, including any need to negotiate stairs during an evacuation, b) the provision of ventilatory support, intravenous therapies and invasive monitoring for patients during such an evacuation, c) the fact that critical care staff may themselves be affected by a fire and therefore be unfit to continue working.  Action cards summarising the evacuation procedure should be displayed within the unit, ideally next to fire call points, so that they can be referred to in an emergency. ","Met or unmet",null,"STANDARDS",6.1]
[3,"Recommendations for the safe use of oxygen cylinders must be adhered to at all times and include: the safe use of oxygen cylinder bed brackets, b) the safe storage of oxygen cylinders and c) following the recommended sequence of events when turning on an oxygen cylinder.","Met / unmet ",null,"STANDARDS",6.1]
[4,"Units must comply with current Department of Health regulations regarding the fire-retardant nature of mattresses, bedding, flooring and curtains.","Met / unmet ",null,"STANDARDS",6.1]
[5,"New units must be designed using Department of Health guidance and in conjunction with the Trust fire safety officer, with consideration given to the provision of: a)multiple exit routes, b) ski pad, ski sheets or other evacuation aids for all bed spaces which are readily available, c) adopting small bays rather than open areas and d) splitting ICU departments into separate clinical and non-clinical areas.","met / not met / not applicable",null,"STANDARDS",6.1]
[6,"Units must have a major incident plan in place which allows for the transfer in of multiple critical care patients from a neighbouring hospital’s critical care unit should it need to carry out an emergency evacuation.","Met / unmet ",null,"STANDARDS",6.1]
[7,"Any problem with oxygen cylinders and associated equipment must be reported immediately to both the medical gas supplier and the Medicines and Healthcare products Regulatory Authority (MHRA).","Met / unmet ",null,"STANDARDS",6.1]
[8,"All staff must undergo regular training in fire prevention and fire procedures, to include training in-situ in the specific clinical areas in which they work. All staff must know: a) the location of fire call points within their own unit and how to operate them, b) the location of fire extinguishers within their unit and which type to use in the event of a fire. Medical and senior nursing staff must also know the location of the medical gas pipeline shut-off valves in their unit, how to operate them and the implications of doing so.","met = > 90% of staff compliant , partially met > 75%,, not met < 75% ",null,"STANDARDS",6.1]
[9,"All intensive care staff must be given basic training regarding the safe use of oxygen cylinders.","met = > 90% of staff compliant , partially met > 75%,, not met < 75% ",null,"STANDARDS",6.1]
[10,"Local unit evacuation policies must be drawn up, with consideration for: a) other locations within the hospital where critical care might be provided on a temporary basis; b) provision of equipment and drugs; c) evacuation case at each bed space; d) triage of patients (the least unwell patients being evacuated first and the most unwell patients last); e) possible co-existing power and/or equipment battery failure; f) use of transport ventilators and hand ventilation if needed; g) temporary discontinuation of renal replacement therapy; and h) transfer of hospital notes especially if electronic patient monitoring is in use. In a major fire, it is possible that serial evacuations will be required with a staged move to the outside, and that the whole hospital may need to be evacuated.","Met / unmet ",null,"STANDARDS",6.1]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Evacuation policies should include liaison with the Bronze (Operational), Silver (Tactical) and Gold (Strategic) commanders in conjunction with the senior fire officer on scene. Timing of evacuation is crucial: if evacuation occurs too early, then patients may be harmed by a transfer; if evacuation occurs too late, then patients and staff may be harmed by fire and smoke.",null,null,"RECOMMENDATIONS",6.1]
[2,"Local fire evacuation policies should be tested regularly, ideally as part of a simulation scenario. Evacuation at night should also be practised.","Met - tested annually , partially met tested daytime only and / or less than annually, unmet, not tested in the last 2 years ",null,"RECOMMENDATIONS",6.1]
[3,"Units should have a system whereby staff involved in a traumatic incident, such as a fire in the critical care unit, receive debriefing and are followed up for signs of a trauma stress reaction or Post Traumatic Stress Disorder (PTSD). The Trauma Resilience Management (TRiM) system is a screening tool used in the military and more recently used successfully in healthcare which could be considered.","Met - system available / unmet - no system in place to do this ",null,"RECOMMENDATIONS",6.1]
[4,"Critical care networks should develop systems to support planning for, and management of, a major incident in one critical care unit within the network, so that other units can cooperate to accommodate all critically ill patients in this type of situation. A retrieval team approach, with staff from neighbouring units travelling to the affected unit to transfer patients, should be planned. Liaison with neighbouring units and local ambulance services at an early stage is advised.","met / not met / not applicable",null,"RECOMMENDATIONS",6.1]
[null,null,null,null,"-"]
[null,null,null,null,"-"]
[6.2,"Major Incidents",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"All hospitals designated receiving hospitals with Level 3 critical care capability must be prepared to double their normal Level 3 ventilated capacity and to maintain this for up to 96 hours.","Met - plans in place to do this - partially met - plans in place but dont meet this standard ( comments box here )  unmet - no plans in place to meet this standard",null,"STANDARDS",6.2]
[2,"All nominated supporting hospitals with Level 3 critical care capability must be prepared to double their normal capacity for Level 3 beds for general use and to support the decant of patients from other receiving hospitals.","Met - plans in place to do this - partially met - plans in place but dont meet this standard ( comments box here )  unmet - no plans in place to meet this standard",null,"STANDARDS",6.2]
[3,"All hospitals with intensive care capacity must have in place plans to support the retrieval or transfer of patients; supporting hospitals must have to support patient transfers by providing suitably skilled transfer teams for each patient needing to be moved within Critical Care Operational Delivery Network areas and beyond.","Met / unmet",null,"STANDARDS",6.2]
[4,"All hospitals must have an evacuation and shelter plan that includes evacuation and shelter of highly dependent patients, including but not exclusively intensive care patients, should the intensive care areas become unusable for any reason.","Met / unmet",null,"STANDARDS",6.2]
[5,"All hospitals must have a lock down plan that includes all intensive care areas, preventing unauthorised access.","met / unmet",null,"STANDARDS",6.2]
[6,"All hospitals must have a recovery plan to ensure a rapid return to normality once the incident is closed. This must include adequate rest and psychological support for staff.","met / unmet",null,"STANDARDS",6.2]
[7,"Action cards must be available for use on activation of plan and must include information and communication routes that are to be used.","met / unmet",null,"STANDARDS",6.2]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Intensive care leads should work closely with the Healthcare Organisation Emergency Preparedness, Resilience and Response (EPRR) leads and clinical colleagues to create the intensive care response to a major incident, hospital evacuation or mass casualty plans.","met / unmet",null,"RECOMMENDATIONS",6.2]
[2,"Intensive care should have access to emergency planning and response training including strategic/crisis leadership.","met / unmet",null,"RECOMMENDATIONS",6.2]
[3,"Intensive care service staff should participate in the local and regional multidisciplinary exercises including ‘table top’ and ‘live’ exercises to further refine local and regional plans and communication routes between organisations and networks.","met / unmet - within the last 2 years ",null,"RECOMMENDATIONS",6.2]
[4,"Intensive care leads should work with their EPRR team to facilitate exercises in the evacuation of very dependent patients from any part of their hospital. This should include practical use of ski sheets, and other patient handling aids, as well as rehearsing the decision making and forward planning required by shift leads to support a controlled, staged evacuation.","met / unmet - within the last 2 years ",null,"RECOMMENDATIONS",6.2]
[5,"Intensive care staff should be prepared to take a central leadership role in any major incident and should be prepared to send teams ‘forward’ to the Emergency Department, as well as any preoperative hold areas and recovery.","met - plans in place to enable to do so, unmet - no plans ",null,"RECOMMENDATIONS",6.2]
[6,"The plan to double the number of intensive care beds should include an inventory of where equipment is to come from, where the beds should be located and who should staff them. This should be near the permanent critical care unit, where possible allowing the normal functioning of the hospital around it.","met / unmet",null,"RECOMMENDATIONS",6.2]
[7,"Advance consideration of staff workforce requirements, including mutual aid from colleagues in neighbouring hospitals should form part of the intensive care service planning.","met / unmet",null,"RECOMMENDATIONS",6.2]
[8,"Staff welfare should be actively supported during an incident and critical care staff access to informal, immediate debrief or later formal counselling.","met - plan in place , unmet - no plan in place",null,"RECOMMENDATIONS",6.2]
[9,"Clinical standards should be maintained as long as possible, critical incident reporting encouraged and contemporaneous note kept to enable quality post-incident lessons to be investigated, communicated and learnt.","met - within plan , unmet - not in plan ",null,"RECOMMENDATIONS",6.2]
[null,null,null,null,"-"]
[6.3,"High Consequences Infectious Diseases: Initial Isolation and Management",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Each critical care unit must ensure there are local contingency plans for the initial isolation and management of critically ill patients with suspected HCIDs. These plans must be regularly practiced and reviewed, including the use of table-top exercises and simulations.","Met - plan in place and tested within 2 years, partially met - plan in place but not tested within 2 yrs, unmet - no plan ",null,"STANDARDS",6.3]
[2,"Units must liaise with local Directors of Infection Prevention and Control to ensure the correct personal protective equipment (PPE) is procured and sufficient stocks are readily available for use by appropriately trained intensive care staff in the event it is required.","met / unmet ",null,"STANDARDS",6.3]
[null,null,null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"A consultant in Intensive Care Medicine should have responsibility for intensive care aspects of local emergency planning and resilience preparations, incorporating plans for the appropriate isolation and management of suspected patients with HCID.","met / unmet",null,"RECOMMENDATIONS",6.3]
[2,"A clinical area where critically ill patients with suspected high consequence infectious diseases may be isolated, either within the unit or elsewhere, should be prospectively identified. Ideally plan to utilise negative pressure rooms with anterooms where available.","met / unmet",null,"RECOMMENDATIONS",6.3]
[3,"All clinical equipment used in the management of a patient with a HCID should be dedicated to that patient alone. Equipment should be single use where possible.","met - within a plan to do so, unmet - no plan ",null,"RECOMMENDATIONS",6.3]
[4,"Training should be provided on a regular basis to ensure critical care staff are familiar with using and safely removing the PPE provided. This should incorporate annual fit testing of respiratory protective equipment (e.g. FFP3 masks).","met - annual fit testing done unmet - not annual fit testing ",null,"RECOMMENDATIONS",6.3]
[5,"Critical care staff providing care for a patient with a suspected or confirmed HCID should be dedicated to the care of that patient on a clinical shift and should not provide concurrent care for other patients, thus limiting the risk of cross-infection.","met - within plan to do so, unmet - no plan ",null,"RECOMMENDATIONS",6.3]
[6,"Contingency planning should incorporate plans for holding securely the large volume of clinical waste resulting from clinical care including discarded contaminated PPE. Once a HCID is confirmed, further advice on correct disposal of the waste will be provided.","met - within plan to do so, unmet - no plan ",null,"RECOMMENDATIONS",6.3]
[7,"Patients with a suspected viral haemorrhagic fever should be risk assessed in accordance with the Advisory Committee on Dangerous Pathogens Viral Haemorrhagic Fever (ACDP VHF) Risk Assessment algorithm and investigations to exclude malaria promptly undertaken, in keeping with local procedures.","met - local procedure in place, unmet - no local procedure",null,"RECOMMENDATIONS",6.3]
[8,"Patients with suspected airborne HCIDs should be risk assessed according to national guidelines where they exist (disease-specific e.g. MERS guidance collections3,4 or generic airborne HCID guidelines, as appropriate).","met - local procedure in place, unmet - no local procedure",null,"RECOMMENDATIONS",6.3]
[9,"Following recognition of a patient with a suspected HCID: a) local infectious disease and/or microbiology and virology services should be notified and advice sought, including guidance on obtaining appropriate diagnostic clinical specimens, b) Local clinicians should liaise with the Imported Fever Service (note this service is available to clinicians across the UK) for further clinical advice and to facilitate access to specialist diagnostics as required, and c) all suspected cases should be reported immediately to local health protection authorities (e.g. the local Health Protection Team).","met - local procedure in place, unmet - no local procedure",null,"RECOMMENDATIONS",6.3]
[10,"Critical care units accepting international medical transfers should perform a risk assessment prior to transfer if a patient is being transferred from a country with known HCID outbreaks or countries where there is a significant risk of specific HCIDs; refer to national guidance (disease-specific or generic HCID guidance).","met - local procedure in place, unmet - no local procedure",null,"RECOMMENDATIONS",6.3]
[null,null,null,null,"-"]
[6.4,"Surge and Business Continuity Planning",null,null,"-"]
[null,null,null,null,"-"]
["STANDARDS",null,null,null,"-"]
[1,"Adult critical care units (in England) must submit twice-daily information on their bed capacity through NHS Pathways Directory of Services (DoS).","met / unmet / NA ( if non English units)",null,"STANDARDS",6.4]
[2,"Each organisation with an adult critical care unit must have their own escalation plan and business continuity plan.","met / unmet",null,"STANDARDS",6.4]
[null,"                        ",null,null,"-"]
["RECOMMENDATIONS",null,null,null,"-"]
[1,"Unit managers and senior clinical staff should develop plans and checklists for scenarios such as: a) supply chain disruption (road/fuel crisis, extreme weather, industrial action or civil disturbance), b) Infrastructure failures (intermittent power cuts or 'brownouts', failure of water or heating), c) interruption of normal staffing patterns (e.g. transport disruption, school closures). Checklists should include, for example, which drugs and consumables would run out first if supplies are disrupted.","met / unmet ",null,"RECOMMENDATIONS",6.4]
[2,"Plans should also include options for: a) Unit evacuation, both internally and externally to other sites in the event of major infrastructure failure, or other events (e.g. fire) which threaten the ongoing operation of intensive care facilities, b) Capability for accommodating intensive care patients evacuated from another site.","met / unmet ( repetition ) ",null,"RECOMMENDATIONS",6.4]
[3,"As lack of critical care capacity is frequently the bottleneck in other surge-events, managers and clinicians should have identified areas within their acute hospital sites to allow for expansion of critical care capacity. This may include use of operating theatres, recovery and augmented higher care areas, or upgrading Level 2 critical care areas to permit mechanical ventilation and Level 3 care.","met / unmet ",null,"RECOMMENDATIONS",6.4]
[4,"If increased activity is anticipated, the increase in requirement for consumables should be quantified using the concept of ‘days of supply’ (i.e. what is needed to run one intensive care bed for a 24-hour period). This should include consideration of oxygen and air supplies.","met - within plan , unmet - not in plan ",null,"RECOMMENDATIONS",6.4]
[5,"Expansion may also require consideration of essential equipment and possible alternatives.","met - within plan , unmet - not in plan ",null,"RECOMMENDATIONS",6.4]

{"sheet":"Lookups","index":9,"n_rows":25,"n_cols":6,"rows_kept":25,"cut":false,"hidden":true,"merged":[]}
["0=Not met",null,null,null,null,"Operational Delivery Network (ODN)"]
["1=Partially met",null,null,null,null,"Birmingham, Black Country, Hereford & Worcester Including Central England"]
["2=Fully met",null,null,null,null,"Cheshire & Mersey"]
["3=Not applicable to Unit",null,null,null,null,"East Midlands Formerly Mid Trent"]
[null,null,null,null,null,"East Of England"]
["Please do not delete or alter this sheet.",null,null,null,null,"Greater Manchester"]
[null,null,null,null,null,"Kent, Surrey, Sussex Critical Care Network"]
[null,null,null,null,null,"Lancashire And South Cumbria"]
[null,null,null,null,null,"London - North Central"]
[null,null,null,null,null,"London - North East"]
[null,null,null,null,null,"London - North West"]
[null,null,null,null,null,"London - South East"]
[null,null,null,null,null,"London - South West"]
[null,null,null,null,null,"North Of England"]
[null,null,null,null,null,"North East & Cumbria Locality"]
[null,null,null,null,null,"North Of England - Tees Valley & South Durham Locality"]
[null,null,null,null,null,"North West Midlands"]
[null,null,null,null,null,"North Yorkshire & Humberside"]
[null,null,null,null,null,"Northern Ireland"]
[null,null,null,null,null,"Scotland"]
[null,null,null,null,null,"South West"]
[null,null,null,null,null,"South Yorkshire & Bassetlaw"]
[null,null,null,null,null,"Thames Valley & Wessex"]
[null,null,null,null,null,"Wales"]
[null,null,null,null,null,"West Yorkshire"]