Intensive Care Units are specialist hospital wards that look after patients whose conditions are life-threatening and need constant, close monitoring and support from equipment and medication to keep normal body functions going. They have higher levels of staffing, specialist monitoring and treatment equipment only available in these areas and the staff are highly trained in caring for the most severely ill patients.

Intensive care is usually only offered to those whose condition is potentially reversible and who have a good chance of surviving with intensive care support.

A prime requisite for admission to an Intensive Care Unit is that the underlying condition can be treated.

A person may be admitted either as a planned admission after major surgery or as an emergency admission following an accident or acute illness.

 

 

Decisions about treatment

When a patient is conscious in ICU they can agree to an investigation or treatment as part of their care. The staff treating them should support their choice of treatment whenever possible.

However, many patients in ICU are unconscious and unable to consent to certain forms of treatment. In this case, the final responsibility for determining whether a procedure is in an incapacitated patient’s best interest lies with the health professional performing the procedure. Nevertheless, we recognise that it is good practice to consult with those close to the patient, unless the urgency of their situation prevents this.

Additionally, the doctors and nurses will always explain what they are doing to a patient even if they don't appear to be able to hear.

Designated decision maker

Under the Mental Capacity Act (2005), someone who knows they are going into intensive care may nominate someone to make decisions about planned treatment on their behalf.

This person is known as a designated decision maker. If the person in the ICU is unconscious, the designated decision maker has the final say about any planned treatments or procedures.

A designated decision maker can only be nominated through:

  • Lasting Power of Attorney – a legal document in which the person in hospital has granted someone the power to make decisions on their behalf
  • Court Appointed Deputy – someone chosen to make decisions on behalf of the person in hospital by the Court of Protection, which is the legal body that oversees the implementation of the Mental Capacity Act (2005)

Therefore, a person who is admitted to an ICU in an emergency is not able to nominate a designated decision maker.

Advance decisions

Some patients decide in advance that there are specific situations in which they would not want certain treatments. "Advance decisions" or "Living wills", as they are sometimes called, are now legally binding. To make an advance decision, you should clearly state your wishes in writing and have it signed by a witness. It is however important to realise that these documents need to be very specific in the circumstances and treatments they describe for them to apply. 

 
 

 

The time it takes to recover varies greatly and depends on things such as age, patient’s fitness, as well as the severity of the condition. Once a person is able to breathe unaided, they no longer need to be in intensive care and can be transferred to a high dependency unit (HDU), which is one level down from intensive care, or to a general ward. Intensive care teams often continue to visit patients on the ward and some units offer follow up clinics to look for problems that are specific to patients who have had long stays and been severely unwell.

 

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