Intensive Care Unit (ICU)
Purple Zone
Level 3
Call: 01634 833967
General High Dependency Unit (HDU)
Green Zone
Level 3
Call: 01634 835045
Whether you are visiting this page because you or a loved one is in critical care, or you are just browsing, we hope you find the information helps to answer many of your questions and relieve some of the anxiety you may be feeling during this worrying and difficult time.
Our critical care department consists of an Intensive Care Unit (ICU), a General High Dependency Unit (GHDU) and an Enhanced Care Unit (ECU) which is split across three separate units.
ICU is a nine-bedded unit and our HDU is a 10-bedded unit. Together the units treat approximately 1,300 patients a year with a variety of medical and surgical conditions.
ECU is an intermediate level of care for elective post-operative patients, where a higher level of observation, monitoring and interventions can be provided than on a general ward. Following a clinical assessment at the pre-assessment clinic prior to attending hospital, the anaesthetist will decide which patients would benefit from an enhanced level of care after surgery.
The critical care units are run by an experienced group of anaesthetic consultants, doctors, Advanced Critical Care Practitioners (ACCPs), nurses, therapists, clinical and non-clinical support staff.
What is critical care?
Critical Care is a term that incorporates both intensive care and high dependency units. Critical care is the treatment and monitoring of people who are in a critically ill or unstable condition.
A patient may require admission to intensive care because they need advanced respiratory support (ventilation), advanced renal support (haemofiltration) or other complex therapies following an acute episode of illness or after receiving a complex operation.
Admission to the high dependency unit may be required due to the complex nature of the patent’s surgical procedure or existing medical condition/s. Alternatively, they may be stepping down from the intensive care unit and need more complex monitoring and intervention prior to going back to a general ward.
Level 0
Patients whose needs can be met through normal ward care in an acute hospital.
Level 1
Patients at risk of their condition deteriorating, or those recently relocated from higher levels of care whose needs can be met on an acute ward with additional advice and support from the critical care team.
Level 2
Patients requiring more detailed observation or intervention including support for a single failing organ system or postoperative care, and those stepping down from higher levels of care.
Level 3
Patients requiring advanced respiratory support alone or basic respiratory support together with support of at least two organ systems. This level includes all complex patients requiring support for multi-organ failure.
As per the Intensive Care Society guidelines, Level 3 patients require a registered nurse to patient ratio of a minimum 1:1 to deliver direct care. Level 2 patients require a registered nurse to patient ratio of a minimum 1:2 to deliver direct care.
This is a guide and therefore from time to time, unforeseen circumstances will arise meaning that your loved one may not receive the desired nurse:patient ratio. However, we endeavour to continue to provide a high standard of care and patient safety remains a priority.
The Early Stages
We understand that it can be a very upsetting and stressful time when your loved one is first admitted to critical care. It is completely normal for you to feel a whole host of emotions.
On admission to the unit, our priority is to settle your loved one in as quickly and as safely as possible so you are then able to come in and be with them. When someone is critically unwell, this process can take longer because of multiple requirements needing to be met in order to support your loved one. This may include them being connected to an array of equipment in order to support them during their time in critical care.
The Unit Routine
The daily routine of a critical care unit is subject to change due to emergencies. The below gives you an idea of what your loved one’s day will entail:
Nursing handover
This happens once per shift and takes place at your loved ones bedside. A nursing handover occurs when one nurse hands over the responsibility of care for a patient to another nurse. It is an opportunity to explain the background of a patient’s condition, what support they are receiving, what has happened during the day and the most up to date plan. It is also when the registered professionals will discuss any medications that your loved one is receiving or will be due during the next shift.
Consultant ward round
All patients are reviewed by the ICU or HDU consultant along with the critical care junior doctors. It is the opportunity for patients to be reviewed and treatment plans to be discussed and put in place. The microbiology consultant will also be contacted to provide advice regarding the interpretation of results from blood samples sent following a patient becoming septic and the appropriateness of further investigations and antibiotic treatment.
Physiotherapy
The physiotherapists role within ICU can be separated into two important areas: respiratory and rehabilitation. Our physiotherapy team will aim to see your loved one on a daily basis, whether it be to help with their sputum load, which may or may not be affecting their oxygenation, or by promoting mobilisation while helping to maintain and improve muscle strength and improve joint movement.
Medications
Throughout the day and night, your loved one will receive multiple medications with the aim of improving their condition. These will range from sedatives, antibiotics, and medications to help with low or high blood pressure and many more. Your loved ones medication is reviewed on a daily basis on the ward round to ensure they are still required or need to be changed. Critical care has a designated pharmacist whose role it is to ensure the safe administration of medication for each patient.
Nursing care
Your loved one will receive care on a 1:1 or 1:2 nurse to patient ratio as previously mentioned. The role of the bedside nurse includes monitoring your loved ones vital signs and adjusting care accordingly, changing their position to prevent pressure sores, administering medication and taking blood tests.
Dietitian
Nutrition during critical illness is vital in aiding your loved ones recovery. The dietitian will aim to see the patient multiple times a week to ensure their nutritional requirements are being met. If your loved one is unable to eat and drink, the dietitian will help ensure they are getting their requirements through a tube – either into the gut or straight into the blood supply.
This is just a small number of health care professionals who will play a part in your loved ones care. The safety of our patients is a priority. We always aim to provide the highest standard of care.
Meet the team
In the critical care unit, patient care is delivered by a highly specialised and varied group of clinical staff who each bring different skills and knowledge to enhance and provide the very best patient care. The department is led by senior consultants and nurses who are supported by staff in several other roles.
Consultants
Critical care consultant anaesthetists are responsible for leading patient care during their stay in critical care. The duty consultant will lead the medical team and take responsibility for admissions, planning treatment and care. The consultant will oversee overall care and ensure that discussions with other specialities within the hospital and beyond are carried out to ensure the patient receives the care they require.
Critical care consultants
- Dr Rachel Krol
- Dr Paul Hayden
- Dr Graeme Sanders
- Dr Pavol Palcovic
- Dr Rahuldeb Sarkar
- Dr Vipal Chawla
- Dr Nandita Divekar
- Dr Rupa Kaur
Critical care doctors
Within critical care we have a number of doctors working at different grades and positions. Among them, we have a team of doctors who are on rotation/placements (known as junior doctors) to help enhance their knowledge and consolidate their skills within critical care. The junior medical team are always supported by senior doctors within the team to ensure there is a good skill mix for each shift, while always ensuring patient safety is priority.
Advanced critical care practitioner (ACCP)
Within our critical care department we have three fully qualified ACCPs and two other qualified healthcare professionals who are currently studying alongside clinical practice to become fully qualified ACCPs. ACCPs work across many clinical boundaries including medicine, nursing, physiotherapy and pharmacology to ensure that patients receive person-focused, timely and effective care.
Critical care nurses
The units are staffed by highly specialised, knowledgeable and experienced nurses. The nursing team is led by Matron Katherine McEvoy.
On each shift there is a sister in charge/charge nurse (either a band 6 or 7) who will allocate nurses to patients, usually on a 1:1 or 2:1 basis. The nurses will care for the patient/s they have been allocated to during their shift, during which they will carefully monitor them, carry out vital signs, and work with the medical and therapy team to ensure the patient’s/patients’ daily care plan is carried out. The nurse will also liaise with family members and doctors to answer any queries and questions that the patient and their loved ones may have.
Working alongside our nurses are clinical support workers (CSWs). They are responsible for assisting the nurses with patient care, assisting relatives with any queries and ensuring equipment on the unit is stocked.
To help you recognise the different nurses and support workers on the unit, below is a brief description of their uniforms:
- Clinical support workers – Grey dress/Tunic
- Band 5 junior nurses – Light blue dress/Tunic with white piping
- Band 5 senior nurses – Light blue dress/Tunic with white piping
- Band 6 sister/charge nurses – Light blue dress/Tunic with navy piping
- Band 7 senior sisters – Navy dress/Tunic with white piping
- Specialist nurses Band 6 and 7 – Navy dress/Tunic with red piping
- Matron – Red dress
Critical care multi-disciplinary team
Primary Care Team
Each patient will have a Primary Care Team caring for them outside of critical care. This may be a surgical or medical team depending on the patient’s diagnosis. Although the Critical Care Team take over a patient’s care at the point of admission to the Intensive Care Unit (ICU)/General High Dependency Unit (GHDU), the team works collaboratively with the Primary Care Team who review the patients on a regular basis. This ensures they are up to date with the current situation and any plans to step patients down from critical care can be discussed.
Physiotherapists
The physiotherapist’s role within critical care can be separated into two important areas: respiratory and rehabilitation. Our Physiotherapy Team will aim to see patients on a daily basis, whether it be to help with their sputum load, which may or may not be affecting their oxygenation, or by promoting mobilisation while helping to maintain and improve muscle strength and improve joint movement.
Dietitian
Within critical care we have a specialist dietitian who is responsible for reviewing each patient’s nutritional needs on a regular basis. Nutrition is vital in aiding recovery during critical illness therefore our dietitian will review patients on an individual basis.
Specialist nurses
Within the department we have several nurse specialists who all have a background in critical care.
Rehabilitation and follow-up nurse
Within critical care we have a rehabilitation and follow up nurse specialist who, along with a team of physiotherapists and a consultant, will plan and review each patient’s rehabilitation from critical care. The rehabilitation and follow up nurse may also offer patients a follow up appointment in clinic, post discharge, to identify and discuss any ongoing needs or concerns that patients have following their stay in critical care.
Audit and quality improvement nurses
The aim of the Audit Team within critical care is to ensure high standards of clinical care are upheld. They look at how the unit communicates and disseminates information between members of the Multi-disciplinary Team, patients, their families and the wider public, to give an open and accurate account of care, planning and delivery throughout critical care. By carrying out audits we are able to look at trends and critically appraise current practice and identify areas for improvement. The Audit Team liaise with the critical care clinicians to determine clear objectives for the audit programme, supervise the collection of data and check the accuracy and consistency of the data that is collected. The Audit Team regularly evaluate, re-evaluate and monitor clinical practice by using credible systems to ensure best possible patient care. Quality Improvement is also a main focus within the audit and Multi-disciplinary Teams to raise standards and promote continuous improvement.
Practice development nurse
Within critical care we have a practice development nurse (PDN). Their role is:
- To provide extensive clinical advice and support to enhance the knowledge base and practical skills of new nursing staff, internationally educated nurses, healthcare assistants and other learners within the department
- To communicate with and assist the Multi-disciplinary Team to promote excellence in the delivery of care
- To either provide or facilitate learning opportunities for the team to maintain clinical competence; nurture and develop skills and knowledge within critical care
- To coach and guide staff in all aspects of professional development.
Bereavement
End of life care
Sometimes end of life care is provided by nursing staff to patients in our critical care units.
We understand that preparing for the death of a loved one is difficult and upsetting. Our staff will always do their best to support you and other family members during this difficult time and will try to help make things a little easier for everyone involved.
The 3 Wishes Project
Medway critical care is currently taking forward The 3 Wishes Project. Developed in the USA, the end of life program aims to enhance the dignity of a dying patient by helping them and their family members make meaningful memories with the overall goal of improving the quality of the dying experience for both the patient and their family. By asking about and carrying out at least three final simple wishes for dying patients, the project is designed to celebrate the patient’s life and support those who are left behind as they deal with their grief. Our nursing staff will always do their very best to accommodate either the patient or their family member’s wishes so please feel free to ask.
Part of The 3 Wishes Project is to develop a critical care garden for patients to visit. We have been working hard within critical care to achieve this and are currently seeking a suitable space within the hospital grounds to develop the garden. In the meantime, our nursing staff are still able to take your loved one outside for some fresh air if this is something that they would like and if it is appropriate to do so.
Namaste care practitioner
Namaste care was developed by Joyce Simard in the USA. It uses a holistic approach to caring for patients who are receiving end of life care, by focusing on the person rather than the process and protocol.
Emily Brown, the Trust’s Namaste Care Practitioner, is available by referral to the End of Life Team. If this is something you would like for your loved one then please speak to the nursing staff.
Music
It’s important that your loved one is as comfortable as possible while they are on our critical care unit. If there is any music that they particularly like to listen to, or background noise, then please speak to the nursing staff so they can help facilitate this.
Remembering your loved one once they are gone
When a loved one dies, there will be many things you remember about them. But as time passes you may find it hard to recall some of those memories. To help you hold on to your memories you might like to consider some of the following items that are available through the critical care unit’s nursing staff:
Blankets – the unit has been donated some beautiful keepsakes to give to dying patients and their families. These can help to create a peaceful environment and help to make positive memories with loved ones during a difficult time. The keepsakes include blankets, generously made and donated by the local community and staff members, which are used by the patient during their final days and can be taken home by their family to keep. Some families have the blankets made in to a cushion at a later date.
Friendship bracelets – matching friendship bracelets and knitted hearts can be offered to the patient and their family members to help them feel a little closer and connected even after death.
Handprints and moulds – nursing staff can take a print of your loved one’s hand and photocopy it so it can be given to other family members. Hand moulds, which may be offered if it is appropriate to do so, make a lovely keepsake to remember your loved one by.
Lock of hair – our nursing staff can help to provide you with a lock of your loved one’s hair.
Memory boxes – memory boxes can be provided but please note they are limited and not guaranteed as they are provided by bereavement charities who rely on funding to be able to provide the unit with them. Memory boxes can be used to store the keepsakes mentioned above in. You may also wish to think about putting other personal belongings in the memory box such as a watch, tie, perfume, letters and photographs or a favourite lipstick, passport or concert tickets, even their favourite book.
Bereavement follow-up calls
Following a patient’s death a member of the critical care senior nursing team will aim to call the patient’s next of kin within the first two weeks. The phone call is to offer our condolences and to ask how they are following their loved one’s passing and to provide further information, answer any questions, or help to put them in contact with any support groups and counselling should they need it.
Bereavement meetings
If you have any questions regarding your loved one’s care in critical care, their treatment, or do not completely understand what happened to them, our nursing staff are more than happy to arrange a consultation with one of our critical care consultants to discuss your worries. Please contact the unit to speak to the nursing staff to arrange this.
Supporting children
Books – within critical care we are fortunate to be able to offer books to support children in bereavement and grief. The books, which are bought from the unit’s charity funds and have been recommended by child bereavement charities/counsellors, aim to help children to understand what has happened and what happens after their loved one has passed away. We can support you with making memories and offering keepsakes such as those mentioned above to support children when their loved one dies.
Charities and free resources – Winston’s Wish is a charity dedicated to bereaved children which offers helpful advice, tips, and activities to support children through a bereavement.
Cruise is a registered charity that offers advice and support for children experiencing grief following a bereavement.
The department of Psychiatry (2023) have some free resources and a step by step guide for families on how to tell children that someone has died.
- Guides for Families — Department of Psychiatry
- Guide for Families: How to tell Children that Someone has Died
Should your child/ren require further support please don’t hesitate to speak to our nursing staff, a bereavement charity or your GP for further advice.
Hospital chaplain/spiritual and pastoral care
We respect and support the spiritual and religious needs of patients and their families. The Trust’s chaplaincy and spiritual care department can offer care in bereavement, end of life issues, facing distressing news, care of the dying and their relatives and the effects of sudden death among many others. Where appropriate the team can provide prayers and certain religious acts, and in an urgent situations they can help to call in a faith leader from a variety of faiths and signpost to similar support in the community. At the patient’s request, or at the request of friends and family, we can contact the hospital chaplain to attend the unit to see you and your loved one. To do so, please speak to a member of the nursing team.
Counselling
Within critical care we have a counsellor who can support patients and staff. However, if you feel you are not coping well, or you are feeling overwhelmed, please speak to our nursing team who will be more than happy to make a referral to the counsellor if you feel it would help you. Please note, there is a waiting list at present but our counsellor will able to provide you with information about further support that is available. You can also speak to your GP about referring you for counselling/further support.
If you have any questions, or anything you would like to discuss, please do not hesitate to contact the critical care unit’s nursing team on 01634 974980.
Useful information – critical care
We understand that having a loved one in the Intensive Care Unit (ICU) can be a daunting and worrying time for you and your family. It is hoped this information will help to answer some of your questions, but please feel free to discuss any concerns with a member of the nursing staff or medical team who are here to help.
We will update you on your loved one’s condition any time of the day or night however due to patient confidentiality, we can only give limited information regarding a patient’s condition over the phone.
Occasionally it may be necessary to set up a password so information is only given to the Next of Kin.
If a large number of family and friends would like updates on a loved one’s condition, please consider allocating a spokesperson who can relay the information to all relevant people.
Photographs
Please note, photographs MUST only be taken by critical care staff and NOT family and friends. This is because the patient’s consent must be sought in order for any photographs to be taken.
Photographs can be a powerful means of helping a patient to understand what has happened to them during their stay in ICU and may enable them to put their experiences and ongoing recovery into perspective.
An initial photograph will be taken by staff within the first 48 hours of admission. Subsequent photos will be taken to show stages of recovery and the layout of the bed space and the critical care unit. Consent for staff to take photographs will be obtained whenever possible.
However, photographs may be taken without a patient’s consent when it is considered to be in their best interest. The potential benefits to the patient permits the taking of a photo of a critically-ill patient at a time when they are not able to express their agreement. Relatives or members of staff may be photographed with the patient if they wish and they give their consent.
Photographs are kept in a digital format and uploaded to a secure system which is only accessible by designated staff. Photographs will not be given to family and friends and they will only be printed if the patient gives consent to keep the photos.
Sick certificates/letters
If a sick certificate is required for a patient’s time in critical care, please speak to a nurse or a member of the team who can arrange this for you. We can support patients and families with a headed letter to employers, GPs, or insurance companies for the period of the critical care admission.
Patient property
Whilst we can accommodate a small amount of patient property on the unit, we would encourage families to take their loved one’s property home with them for safekeeping. Should valuables remain on the unit they will be documented in our valuables property book and sent to the hospital’s safe to ensure they are kept in a secure location. These can be retrieved by the unit staff when requested by the patient.
Following the death of a patient their next of kin will be able to retrieve their loved ones belongings.
Wi-Fi
Free Wi-Fi is accessible to the public throughout the hospital.
Infection control
To protect our vulnerable patients, all visitors to our critical care units are asked to wash their hands prior to visiting and after they have visited their loved one. On occasions certain Personal Protective Equipment (PPE) may need to be worn when visiting the unit. If PPE is required the nursing team will speak to you either prior to your visit or on arrival.
Please do not visit the unit if you are feeling unwell or you are displaying symptoms of COVID-19.
If you are concerned about the risk to your own health when visiting the unit, please speak to the nurse in charge.
Same sex accommodation
We appreciate the importance of same sex accommodation for the comfort, privacy and dignity of patients. While we aim to achieve this there may be times within ICU, the High Dependency Unit and the Enhanced Care Unit (ECU), where this is not possible due to the severity of illness of our patients. If you are concerned about mixed sex accommodation please speak to the nurse in charge.
Patient diaries
Patients who have received care on the Intensive Care Unit (ICU) often have little or no memory of their stay. This can be due to the illness itself or the sedative drugs they were given to keep them comfortable. Some patients may also remember or suffer ongoing nightmares or hallucinations from their time on the unit.
Although doctors and nurses explain to patients why they were admitted to ICU, patients sometimes forget what they have been told. Research suggests that patients can become stressed and anxious when they do not fully understand what was wrong with them. To help patients understand more about their illness and their stay on ICU, our staff have introduced patient diaries, which have been shown to help reduce stress in patients after they are discharged to a ward and in the months following their stay.
The nursing staff will make diary entries to explain why the patient was brought to ICU, what is wrong with them and how they are progressing. We encourage family members to add messages in the diary too, including any news from home they might like to know about. To do this simply speak to the nurse looking after your relative about what you would like them to add on your behalf. Please avoid using any language that could cause offence to the patient or others who may read the diary afterwards.
Once the patient is well enough and they have been moved to a general ward, the ICU nursing team will make contact with them and go through the diaries in person with them.
If you have any questions about patient diaries, please do not hesitate to ask the nurse looking after your relative.
Please remember that the diary is hospital property until handed over to the patient. Diaries must not be taken away from the bedside by family members.
Rehabilitation
How you can help…
Rehabilitation starts on day one of admission. As your relative’s condition improves it is important that they start to feel like themselves again. To help with this process, we ask that you bring in:
- Photographs of those important to the patient
- Mobile phone
- Cards from loved ones
- Drawings/letters from children within the family which can put up around the bed space
- Loose fitting clothing/cardigans/pyjamas as these items of clothing are easy to put on and remove
- Loose fitting underwear
- Appropriate footwear/slippers
- Headphones to listen to music – please speak to the nursing team about the patient’s preferred choice of music
- DVDs
- Kindle/books
- iPad/tablet
- Toiletries, detangle brush/comb
- Netflix/Disney/Now/Amazon Prime account information for your loved one to login to – if you have an account and your relative would like to use it please let the bedside nurse know so that this can be set up.
This is Me
You can help your relative by completing the ‘This is Me’ document, which will help us to support your relative in an unfamiliar place. It includes information such as your relatives preferred name, what their hobbies and likes are and what is important to them. You can download a copy to print so you can complete it at home and bring it with you when you visit. Alternatively, please speak to your relative’s nurse who can print you a copy of the form so you can complete it on the unit.
Lastly, you can help to support your relative by looking after yourself. We appreciate that eating and resting is difficult at such a stressful time but it is very important that you maintain your energy and strength.
Follow up information
The critical care follow-up clinic provides an opportunity for the nursing team to discuss with patients what they should expect from their recovery and for the nursing team to see what progress has been made after the patient has been discharged from ICU.
Patients who have been in critical care for more than three days, or were ventilated during their ICU stay, will receive a letter inviting them to attend a follow up appointment approximately two to three months after they have been discharged from hospital. However, any patient who has been in critical care is also welcome to self-refer and book an appointment via the email at the bottom of the letter.
The aims of the intensive care unit (ICU) follow-up clinics are based on the principles of the NICE guideline 83 (2017) for rehabilitation after critical illness, these include:
- Providing information for patients or relatives on their ICU stay. Patients can discuss any concerns about memory problems and their recovery
- Identifying, supporting and providing guidance to patients and relatives regarding physical and psychological issues
- Facilitating onward referrals for specialist care (medical and psychological)
- Providing a contact person for on-going support
- Functional assessments
- Individualised staged rehabilitation programmes.
An important aspect is to also gather feedback on the experience and delivery of the care we provided to both patients and their families while they were on the unit so we can understand what we did well and where improvements can be made.
The critical care follow up clinic is run weekly on a Monday afternoon.
For more information please contact Clinical Nurse Specialist, Critical Care Rehabilitation and Follow Up Nurse, Hanna Ramanouskaya – h.ramanouskaya@nhs.net
Other useful resources The ICUsteps website is a highly recommended free support service for former ICU patients. It was founded in 2005 by former ICU patients, their relatives and ICU staff and includes an online community group. Other resources that may be helpful include:
- Asthma UK Asthma
- British Heart Foundation
- BRAKE | The Road Safety Charity
- British Association for Counselling and Psychotherapy British Association for Counselling and Psychotherapy
- The Colostomy Association Colostomy UK – A UK charity supporting people with a stoma
- Cruse Bereavement Care Home – Bereavement Support
- Medway Talking Therapies
- Diabetes UK Diabetes UK
Facilities
Shower room – Please feel free to use the relatives’ shower room. A member of staff will assist you in unlocking the room and can provide you with towels if required.
Waiting area – Please help yourself to the complimentary teas and coffees that are available. If supplies need replenishing please speak to a member of staff. A TV and a selection of books and children activities are also available in the waiting area.
Car parking – Seven-day concessionary parking is available for relatives and carers of critical care patients. Please ask the nursing team for a form. Please note the complimentary parking is one per family.
Visitors’ rooms – We have two rooms available for relatives to use overnight. Please note, if the rooms are used overnight they need to be vacated by 8.30am the following day so they can be cleaned. The key must also be handed into the ICU nurses’ station and not taken off the unit. The rooms are kept free during the day so doctors and nursing staff can meet to discuss confidential information regarding patients with their relatives.
Mobile phones – We politely request these are placed on silent and calls are taken or made away from the patient’s bedside.
Food and drink – Please be aware that while food and drink are not permitted at the patient’s bedside these can be consumed in the waiting area on the unit. If you require refreshments you can visit the League of Friends shop, which is located in the main entrance of the hospital on Level 2. The shop sells hot drinks and food, as well as cold drinks, snacks, sandwiches, newspapers, magazines, and essential toiletries. It is open Monday to Friday from 8am to 8pm, weekends 8am to 6pm and bank holidays from 8am to 4pm. Below Deck Galley (located on Level 1 in the Purple Zone) is also open to visitors and people attending outpatient appointments from 3pm to 7pm Monday to Friday and 8am to 7pm on the weekend.
Friends and Family Test
Patient feedback is really important to us. Listening to the views of patients, and their friends and family, allows us to understand what is working well, and what we need to do to improve our services to ensure we deliver the very best of care to patients at all times. It also allows us to improve the hospital environment for everyone.
Our Friends and Family Test (FFT) provides all patients, as well as their carers and loved ones, the opportunity to leave feedback on their care and treatment. The questions are short and simple and the survey takes no more than a few minutes to complete.
You can access the FFT in a variety of ways. You can either click on one of the links below, or use the camera on your handheld mobile device to scan the QR code displayed on posters and / or pull-up banners on the unit. Some of our staff may also show you a QR code on a sticker on the back of their staff ID badge. When you scan the QR code simply click on the link that appears to be taken to the FFT to complete. You will need to click on the drop down menu to select the area you or your relative attended or were cared in.
However you choose to access the FFT, which is completely anonymous, we encourage you to be as honest as you can about your, or your friend or family member’s, experience of our services, staff, and procedures. There is also a section for you to make suggestions for improvements. We really do welcome your honest feedback as it allows us to make the changes that matter to you, and in turn helps to improve the experience for others.
If you have any queries about the FFT, or if you have any issues accessing the link below then please email medwayft.qualityandgovernance@nhs.net
- Adult Friends and Family Test
- Please contact us if you would like to raise a concern or make a complaint
Accommodation
Below is a list of nearby hotels should you require accommodation when visiting loved ones in critical care.
Travelodge Chatham Maritime
Distance: 2.41km
Chatham Historic Dockyard,
Western Avenue
Chatham,
ME4 4NT
The Ship & Trades
Distance: 2.75km
Maritime Way, Chatham Maritime
Chatham,
ME4 3ER
01634 895200
Premier Inn Gillingham / Chatham Victory Pier
Distance: 2.09km
Blake Avenue
Gillingham,
ME7 1GB
Te: 03333 219353
Premier Inn Gillingham Business Park
Distance: 3.37km
Will Adams Way,
Gillingham,
ME8 6BY
Find a pharmacy
You can find a nearby pharmacy by visiting the NHS website.
Research in Critical Care
Our intensive care unit (ICU) actively supports medical and nursing research to improve patient care. Several research projects, mainly about sepsis and airway disease, are currently underway in the unit.
You/your relative may be asked to take part in one of our research studies, either while you are waiting to come into hospital/ICU, while you are in hospital or even after you have returned home. If approached, you will be given detailed information about the study and time to decide whether or not to take part. There is no obligation to participate and your treatment will not be affected in any way if you say no or if you say yes but change your mind at a later date and withdraw your consent.
In order to carry out research we may need to access your medical records. Before doing so, we will present a plan of investigation to the Research Ethics Committee for their approval. This is to assure that the research will be conducted to high standards and that your personal details will be kept confidential.
A legal representative can be asked to give consent on behalf of an adult lacking capacity to do so themselves. In ICU this will usually be a doctor. The legal representative is a person not connected with the conduct of the trial who is suitable to act as the legal representative by virtue of their relationship with the adult, and is available and willing to do so.
If one is not available the personal legal representative must be able to consent on the behalf of the adult.
The personal legal representative must be:
- Told that they are being asked to give consent on behalf of the incapacitated adult
- Told that they are free to decide whether they wish to make this decision or not, and
- Told that they are being asked to consider what the adult would want, and to set aside their own personal views when making this decision.
Why should I/ my relative get involved in research?
The modern NHS aims to provide the best possible care for its patients and the only way to decide which methods of care are best, is through research.
Clinical research is entirely dependent on the assistance offered by patients, and does not affect usual standards of care.
The specialist nature of our work means the results of our research are often of national and international significance and are made freely available through conference presentations and publications in medical and nursing journals.
Many patients are very pleased to have the opportunity to take part and to give something back to the NHS.
What could I be asked to do?
Most research studies are designed so that patients are asked to do only one or two things in addition to having their routine treatment. For example we might ask you or your relative to fill out some questionnaires, provide a blood or tissue sample or have an additional test.
If we need a sample of your blood or tissue for future research we will ask you to sign a separate form consenting to this. Any information about you will be held anonymously.
How will I understand what the research is all about and what it might mean for me/ my relative?
A member of the research team will explain the study and give you a leaflet containing further details. You will be asked to take time to discuss it with your family, friends and GP if you so wish.
The information sheet will have the contact details of the research team should you need further information or advice at any stage.
When you return to hospital a member of the research team will be available to discuss the study further and answer any questions.
If you are happy to/for your relative to participate you will be asked to sign a consent form. You can withdraw your consent at any time without giving a reason and this will not affect your treatment, either now or in the future.
We run studies across the whole of Medway Maritime Hospital and within the community. You can contact us if you are interested in participating in research outside of the ICU department.
A study exploring the genetics of critically ill patients, who could be more susceptible to infections.
A UK trial for treating patients with COVID in and outside of the ICU.
At the beginning of COVID-19 we were looking into ways of treating COVID-19 and reducing the severity of the illness. As time has passed we have found treatments that work and some that haven’t. Each successful treatment has been standardised for the NHS treatment of COVID-19.
A trial to provide safe sedation to patients in ICU.
A trial looking at three rapid tests to detect fungal infection. Producing faster results for more accurate treatment sooner.
Typically, 7 per cent of patients in ICU receive treatment for fungal infection and the majority are started on a presumptive basis. Of these, only 1 in 20 have fungal infection confirmed.
A trial looking at whether using a lower oxygen target (conservative oxygen therapy) to guide oxygen treatment might lead to better outcomes for patients when compared with the approach currently used in the NHS.
A trail designed to determine whether use of mucoactives in critically ill patients with acute respiratory failure improves outcomes and is cost effective, compared to usual airway clearance management, while mechanically ventilated.
We wish to investigate whether giving deceased organ donors a single dose of the drug Simvastatin, a very inexpensive and safe drug, is beneficial for transplant recipients.
All organs removed from donors have already suffered a degree of damage. As the brain dies chemicals are released which cause an inflammation of the whole body. Measurements of this inflammation link to how well the organs function in the recipient after transplant.
In parallel, we know the cholesterol-lowering drugs statins have benefits across a range of health problems which go beyond the direct benefits on cholesterol. In particular, statins damp down inflammation in the body and in individual organs and protect the lungs and kidneys in a range of illnesses.
A trail evaluating the clinical and cost-effectiveness of sodium bicarbonate administration for critically ill patients with acute kidney injury (AKI)
The importance of this research, for critically ill patients in the NHS and globally, hinges both on the prevalence of AKI, which is associated with an increased risk of mortality, prolonged critical care unit and hospital length of stay, and development of chronic kidney disease (CKD)
Audit and Quality Improvement
Clinical audit plays a vital role in clinical governance and also forms the stepping stones for quality improvement projects, at the heart of which is patient care.
The aim of the Audit Team within critical care is to ensure high standards of clinical care are upheld. This includes communicating and disseminating information between members of the Multidisciplinary Team, patients their families and the wider public, to give an open and accurate account of care, planning and delivery throughout critical care.
Through audits we are able to look at trends and critically appraise current practice and identify areas for improvement. The Audit Team liaise with the critical care clinicians to determine clear objectives for the audit programme, supervise the collection of data and check the accuracy and consistency of the data collected. The Audit Team regularly evaluates, re-evaluates and monitors clinical practice by using credible systems to ensure the best possible patient care. Quality improvement is also a main focus within the audit and Multi-disciplinary Teams to raise standards and promote continuous improvement.
Here at Medway, the Critical Care Team participates in a national clinical audit called the Case Mix Programme which looks at the outcomes of patients admitted to critical care. This audit is managed by the Intensive Care National Audit and Research Centre (ICNARC), however patient data is collected locally by our critical care audit nurses. We collect data on all patients admitted to our intensive care and general high dependency unit and securely submit this data to the ICNARC Team for validation and analysis. A quarterly report is received by the unit showing how our unit compares to similar critical care units that are also involved in the programme. These reports focus on a key set of quality indicators and identify trends over time which helps us to understand more about the care that we deliver. This data helps us with decision making, resource allocation and local quality improvement initiatives. Our unit aspires to excellence and clinical audits help us to learn from the top performing units while transferring and adapting information from audited data to our own unique conditions.
The Case Mix Programme also provides the backbone for several important research studies and is a useful resource for many types of data analysis.
The annual Case Mix Programme report is available publicly via the ICNARC website.
Within our critical care units we also use local audit tools for developing local standards, policies and procedures. Audits have a huge impact within critical care in minimising risks and improving quality, safety and the sustainability of patient care and outcomes.
Critical Care: Charity and Donations
The Medway Hospital Charity uses your generous donations to make a difference to our patients’ and families’ lives. Whilst we encourage general donations, to help as many people as possible, we understand you may want to donate to specific areas to say thank you.
All donations to our unit are gratefully received. Donations are used in many different aspects of work within our critical care unit to benefit the care and experience of patients, relatives and staff.
We have received many wonderful donations, all of which are appreciated. Here are examples of how money has been spent and items that have been gifted to the unit by patients, families and friends.
- Visitors’ rooms and waiting area chairs and bookcases – We strive to make our visitors’ areas a calm and comfortable place to wait when visiting their loved ones
- iPads for patient use – The iPads have been very useful for our patients’ rehabilitation. Patients can play games on the iPads, video call their relatives and it is a useful tool to entertain patients, assist with concentration and help to reduce fatigue
- Rehabilitation equipment. Hand grip strengthens, hand therapy balls and resistance bands – This kind of equipment is very important in the rehabilitation of a critically-ill patient and can be used early on in the rehabilitation process. Rehabilitation equipment can improve physical and non-physical functioning such as exercise, muscle strength, walking ability and concentration, in turn reducing the length of hospital stay
- Writing boards to help patients communicate – Unfortunately due to medical devices, some of our patients are unable to speak therefore communication can be difficult. Writing boards have made it easier for these patients to communicate their needs. When these are used it also helps with hand-eye coordination and strength
- Toiletries, detangle brushes, deodorant, shaving foam – Often, due to the emergency situation many of our patients find themselves in, they come in to hospital without their own toiletries. Having nice shower gel, deodorant, shampoo, razors etc can make patients feel like they have some home comforts during their stay in critical care. Detangle brushes have been extremely helpful in critical care; we try to wash our patients’ hair on a regular basis but having a good brush and some leave in conditioner helps us to maintain a patient’s hair so that it does not become matted while they are spending time recovering in bed
- DAB+ radios – Radios have been very well received by our critically ill patients. We often ask our patients and families if music is important or liked by them/their relative and if they would like us to have the radio on at the patient’s bedside. Music soothes and relaxes some people even when they are sedated in the Intensive Care Unit. Music can also act as an escape for some of our patients
- Portable DVD player – We have been donated a portable DVD player, this is great for those patients who wish to watch their favourite film at their bed space
- Activity books/word searches for patients – This helps to engage our patients’ minds and helps with concentration post critical care
- Digital clocks for every patient bed space – We received a donation of digital clocks for each bed space to help patients establish the date and time. When a patient is critically ill, simple things such as the date and time can be difficult to comprehend and remember, so having a visual reminder for each patient helps to prevent and manage delirium and confusion
- Knitted hearts and blankets – We were generously donated many knitted hearts during and after the Covid pandemic. These have been a great comfort for families experiencing bereavement. Blankets have also been made and donated by the local community to help comfort dying patients. Families can then take home the blanket home with them as a keepsake once their loved one has passed
- Bereavement resources – Bereavement resources have been purchased using the charity money we have received. These include bereavement books for children, information for parents, friendship bracelets, handprints and hand moulds. All of these resources are used throughout critical care to support bereaved families.Memory boxes – Our bereavement resources help to support families to make memory boxes.
- LED ceiling picture panel – LED ceiling picture panels were installed using charity donations to help give the illusion of natural light in the annex area of the unit to help patients distinguish day from night so they can establish a healthy wake/sleep cycle which in turn helps in the rehabilitation journey
- Colouring books/puzzle books/colouring pencils – Activities to keep patients entertained
- Pen torches for nurses – These are important in assessing our patients’ neurology
- Lights for PCs – During a night shift we aim to keep the lighting low in order to promote sleep, this can make it difficult to access a patient’s records at the bedside PCs. Small lights that are kept at each bedside PC help the nursing staff to see the keyboard to access patient records while maintaining low lights for a night time environment
- Headphones – Headphones have been helpful for some patients who wish to block out the background noise of the hospital environment while listening to music/watching television or falling asleep
- Eye masks and ear plugs – A critical care environment can be very noisy and busy. Some patients benefit from eye masks and ear plugs to help promote sleep
- Phone chargers – Phone chargers have been donated which helps when patients are awake and able to use their mobile phone to contact their family and friends.
Our fantastic charity team have set up a Critical Care JustGiving page which ensures donations come straight to the unit.
If you would like to donate in another way then please contact The Medway Hospital Charity Team.