ADMINISTRATIVE CLINICAL Page 1 of 6. Origination Date: 6/2009, 10/2009

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1 ADMINISTRATIVE CLINICAL Page 1 of 6 INTRA-FACILITY TRANSPORT OF CRITICALLY ILL PATIENTS TO AND FROM SPECIAL CARE AREAS Origination Date: 6/2009, 10/2009 Revision/Reviewed Date: 9/2010 8/2011, 1/2013; 4/2014 I. POLICY STATEMENT: Grady Health System staff will expediently and safely transport all critically ill patients to and from special care areas. The patient s condition at the time of transport shall govern the level of support (personnel, monitoring, and supportive equipment) needed to safely transport the patient. II. III. PURPOSE: The purpose of this policy is to establish guidelines for the safe transport of critically ill patients to and from special care areas when diagnostic testing or procedural interventions are not available at the bedside. PROCEDURES: Because the transport of the critically ill patient is potentially hazardous, the transport process must be organized and efficient. Careful planning is required to move these patients between hospital facilities such as the operating room, ICU, Emergency Department, imaging rooms and in-patient units. To provide for this, at least four concerns need to be addressed through written policies and procedures: communication, personnel, equipment and monitoring A. Communication and Coordination 1. The RN responsible for the patient shall notify Respiratory Therapy or other appropriate ancillary services as to the timing, equipment, and/or support needed for the safe transport of the patient. 2. The area to which the patient is being transported shall confirm readiness to receive the patient. If the patient is being transported to an area for diagnostic testing, the testing should begin immediately upon the arrival of the patient in the area and with each transfer of caregiver. 3. The transporters, nurses, and other healthcare providers involved in the transport will use SBAR- handoff communication when the patient arrives in the receiving area. 4. The responsible physician will provide orders to include monitoring of vitals, medication orders, and immediate treatments required during. 5. Use appropriate down time forms to document pertinent treatments and vitals into the medical record which is to be entered into Epic as soon as feasible.

2 6. Document the transport and hand-off of the patient in the medical record. B. Transport Categories, Equipment and Personnel 1. Minimum Transport Support Patient Condition: Stable vital signs NOT on intravenous antiarrhythmics, vasopressors, or inotropes. Breathing spontaneously with or without tracheostomy Not on mechanical ventilation May be sedated/obtunded, but must be easily arousable to time/place Transport Personnel: Two staff on every transport (one must be an RN) Transport Equipment/Monitoring on Transport Monitoring should be equivalent to that available on the originating area. Equipment should include: Cardiac monitor/defibrillator (3 or 5 lead EKG) BP monitor (NIBP cycling or monitored A-line) Pulse oximeter Necessary medications and fluids sufficient for the duration of the trip Sufficient oxygen (as indicated) for the duration of the trip plus 30 minute reserve An ambu-bag and mask (per RT) Intubation Tray Infusion pumps(s) (as indicated). All pumps must have sufficient charge to last for the duration of the transport. Maximum Transport Support Patient Condition: Patient may have stable or unstable vital signs Patient may be on IV vasopressors, inotropes and/or antiarrhythmics On mechanical ventilation and may require a transport ventilator. May or may not be sedated or paralyzed.

3 Transport Personnel: Two staff must be on transport (one must be RN and one must be RT or anesthesia). These staff must remain with the patient until SBAR handoff has occurred to staff with the same level of skill/licensure at destination or back in the originating special care area. Post-operative patients in transport to special procedure areas will require a critical care nurse (from Rapid Response team or PACU, if available) and RT or Anesthesia LIP and a physician immediate available An ACLS or ATLS trained physician must be immediately available to accompany the patient on transport. Transport Equipment: Monitoring should at least be equivalent to that available on the originating area. Equipment should include: Cardiac monitor/defibrillator (3 or 5 lead EKG) BP monitor (NIBP or monitored A-line) Pulse oximeter Necessary medications and fluids sufficient for the duration of the trip Sufficient oxygen for the duration of the trip plus 30 minute reserve An ambu-bag and mask (per RT) Intubation Tray Infusion pump (s) as indicated. All pumps must have sufficient charge to last the duration of the transport. IV. DEFINITIONS: Special Care Areas - Emergency department (ED), intensive care units (ICUs), operating rooms (ORS), Post Anesthesia Care Units (PACU), telemetry, and step-down units. General Care Areas - General medical and surgical floors, ancillary service areas (e.g. physical therapy, occupational therapy), and the outpatient clinics. Diagnostic Areas - Diagnostic radiology (angiography, nuclear medicine, MRI, CT scan) and Cardiac Catheterization Lab. Licensed Independent Practitioner (LIP) - MD, DO, CRNA, PA, PAA, or NP.

4 V. REFERENCES, CROSS REFRENCES OR REGULATORY INDEXING: Jonathan Warren, Robert E. Fromm Jr, Richard A. Orr, Leo C. Rotello, H. Mathilda Horst, American College of Critical Care Medicine. Guidelines for the inter- and intrahospital transport of critically ill patients. Critical Care Medicine 2004; 32: Australasian College for Emergency Medicine, Joint Faculty of Intensive Care Medicine Australian and New Zealand College of Anaesthetists. Minimum standards for transport of critically ill patients. Emergency Medicine 2003; 15: Safety in Anesthesia and Intensive Care Study Group (SIAARTI). Recommendations for inter- and intrahospital transport of critical patients. Minerva Anestesiologica [Ital] 2006; 72: Infection Control Policy I. ATTACHMENTS: A. Attachment A: Role responsibilities for collaborative transport of patient from OR to special procedure area

5 ATTACHMENT A INTRA-FACILITY TRANSPORT OF CRITICALLY ILL AND EMERGENCY PATIENTS TO AND FROM SPECIAL CARE AREAS : Attachment A - Role Responsibilities for Collaborative Transfer of OR Patients to Special Procedure Area OR (PACU*) to Angio / CT Transports Utilizing the Rapid Response Team (RRT) Trauma Service physician responsibilities: Notify circulating nurse in OR as soon as it is determined that a transport to Angio / CT is necessary Provide a verbal order to the RRT to utilize the Operating Room Transport Orders Accompany the patient to Angio / CT and remain in attendance with the patient until patient is delivered to the OR, ICU or PACU Sign the paper copy of the Operating Room Transport Orders for RRT Circulating Nurse (PACU RN*) responsibilities: Call RRT ( )when directed by Trauma Service and notify them of pending transport to Angio / CT Page Respiratory Therapy ( ) to set up ventilator in Angio / CT if patient is intubated Obtain an IV infusion pump from PACU for transport Anesthesia responsibilities: Ensure sufficient medications and oxygen for transport and monitor patient during transport to Angio / CT If the patient is stable, provide handoff report to RRT nurse once in Angio / CT If the patient is unstable (i.e., requiring a Level One for massive transfusion, requiring ongoing vasopressor support with continuous vasopressor infusion and frequent boluses to maintain BP), remain with the patient and RRT in Angio / CT. Ensure adequate IV access (CT with contrast requires 18 gauge or >) Respiratory Therapy responsibilities: Set up ventilator in Angio / CT Provide support as necessary during procedure and transport back to ICU or PACU RRT responsibilities: Once notified of pending transport, assure appropriate equipment in Angio / CT (suction, monitor, etc). Complete Operating Room Transport Orders using verbal order from Trauma service physician Surgical must provide verbal or written orders for treatment (medications provided in pyxis in Angio/CT/MRI) Notify OR that he/she is awaiting patient s arrival in Angio / CT

6 Receive handoff from Anesthesia when patient arrives Provide critical care while the patient is in Angio / CT Call charge nurse in 7L to send any equipment needed but not present in Angio / CT (i.e., Level I Infuser) Accompany the patient back to the OR, ICU or PACU Notify Attending Physician on call immediately if resident has to leave CT or Angio for longer than 5 minutes Complete necessary forms for narcotics used on patient and leave with Pharmacy if necessary *PACU patients requiring transport to a procedural area will be transported by a PACU nurse if the staffing level allows. If staff is not available, the RRT RN may be called. All intubated patients must have either RT or anesthesia present on transport. Last revision/reviewed: 1/2013; 4/2014