Wellington ICU forms libraryWellington ICU

Forms & Protocols

Online Library

These resources are for the use of staff in Wellington ICU. They are used to improve the safety and care we provide to our patients. All forms are available in PDF format for download & printing. The online versions available here will always supercede any other.

Clinical Videos


The staff of Wellington ICU have developed clinical training videos, accessible below.

Serial Data


Bedside serial blood gas, haematology & biochemistry sheet

ICU Trauma


Standardised assessment & documentation of all ICU trauma patients

Spinal Clearance


Stickers to clarify need for spinal precautions in patients with traumatic injury

Intubation Checklist


Safety checklist for use prior to any planned intubation in the ICU

Tracheostomy Emergency ICU


Emergency tracheostomy management poster for bedside display in ICU

Tracheostomy Emergency Ward


Emergency tracheostomy management poster for bedside display in a ward

Tracheostomy Checklist


Checklist for use in the insertion of percutaneous tracheostomies in the ICU

Tracheostomy Weaning


Guidance & documentation for tracheostomy weaning in ICU patients

DTI Setup


Preparing a patient and equipment for respiratory weaning via a Direct Tracheostomy Interface

TRAMS


Stickers to standardise ward review of patients seen by the ICU Tracheostomy Review And Management Service

Above Cuff Vocalisation


Protocol for enabling speech in patients with Portex Suctionaid tracheostomies

Subglottic Secretion Aspiration


Protocol for aspiration of subglottic secretions in patients with Portex Suctionaid tracheostomies

COVID-19 Intubation Checklist

See Videos page for demonstration


Modified intubation checklist for suspected or confirmed COVID-19 patients in ICU

ICU Handover


Standardised tool to improve accurate structured information exchange

ICU Treatment Goals


Document to assist with alignment of ICU treatments and patients' known wishes, to prevent unnecessary treatments that are neither wanted nor warranted

ICU Insulin Sliding Scale


Insulin sliding scale protocol for hyperglycaemic ICU patients. Includes pathway for transition to hospital insulin chart. Not for use in DKA or HHS.

Allow A Natural Death


Checklist to improve the quality of end-of-life care in ICU

Difficult Airway Poster


Poster to display at the bedside of patients who are known to have a difficult airway. Includes emergency contact details.

Gastric Feeding


Gastric feeding protocol for adults in ICU pending dietitian advice

Jejunal Feeding


Jejunal feeding protocol for adults in ICU pending dietitian advice

Stopping Feed


Guidelines on when to stop feed for procedures in ICU or theatres

Neurovascular Observation


Assessment & documentation of neurovascular limb observations for patients at risk of compartment syndrome

Retrieval Triage


Standardised triage tool for aeromedical retrieval and interhospital transport based on Priority and Category. Includes Adult, Paediatric and Neonatal patients

Early Warning Score System


The Capital Coast DHB EWS system has its own dedicated website. This has largely been replaced by the New Zealand EWS (NZEWS) system

ICU Drug Manual


The previously available PDF has now been replaced by a searchable online database. The old version is no longer supported and should not be used.

RESOURCES


All forms are © Wellington ICU. They are made available here as a central resource for staff use to improve the quality of care we provide for our patients. If you wish to adapt any document for local use within your institution, please enquire via the contact link. All editable master copies only exist as Apple Pages documents; converting to Word breaks most things so please don't ask.

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