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hospital_guides:nih [2026/07/21 18:19] – [Weekends] adminhospital_guides:nih [2026/07/21 19:13] (current) – [Writing Notes] admin
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 ====== NIH CC ICU Guide ====== ====== NIH CC ICU Guide ======
 +
 +[[https://102pager.nih.gov/ | Paging System]]
 +
 +[[https://www.amion.com/routing?access_code=nihcc | ICU Schedule]]
  
 ===== Admitting Services ===== ===== Admitting Services =====
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 $^{c}$Attendance is required. Attending or NP holds the ICU phone $^{c}$Attendance is required. Attending or NP holds the ICU phone
 +
 +==== Weekend Specifics ====
 +
 +  * Start rounds at 8:00am **with the //post-call// fellow** and CCMD attending.
 +  * Saturday: Friday PM fellow and NP will share responsibility for writing notes for all the patients on Saturday AM.
 +  * Sunday: The Saturday post-call fellow is responsible for writing notes for all patients on Sunday after midnight. If it is too busy, then the on-coming AM fellow needs to be informed to write them.
  
  
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 === H&Ps === === H&Ps ===
  
-We do not write H&Ps; they primary team does.+ICU does not write H&Ps; they primary team does.
  
 We write a transfer / accept note, largely copy-pasted from the admitting team's note. We write a transfer / accept note, largely copy-pasted from the admitting team's note.
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 === Progress Notes === === Progress Notes ===
  
-  * Daily notes are the ''Critical Care SOAP'' notes. You must co-sign the CCMD Attending with each daily SOAP note +  * Daily notes are the ''Progress Note - Critical Care SOAP'' notes. You must co-sign the CCMD Attending with each daily SOAP note 
  
 ===== Admissions ===== ===== Admissions =====
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 ==== Consults/Upgrades ==== ==== Consults/Upgrades ====
  
-  * For anyone that wants a patient transferred to the ICU, you must see the patient before bringing them to the unit. There is a wide range of clinical experience among practitioners here - some are not very good at identifying a sick patient; you will get urgent calls to see patients who are fine and can stay on the floor and relaxed-sounding calls about patients who are very sick and need emergent care.  +If on arrival to a consult: 
-  * If the patient needs immediate care (intubation, pressors etc.) DO NOT MOVE… CALL A CODE so you can get more help/equipment right away  + 
-  * If they are not crashing and patient needs to be upgraded, call the ICU charge nurse for a bed, and ask the floor nurse to call report +__**Patient is Crashing**__ 
-  * Floor patients need an order to transfer to the ICU census, the primary team should do it but in the essence of time, we can do it as well.   + 
-  * If patient remains on floor, use document “Critical Care Free Text” to write your assessment and recs +Needs immediate care (intubation, pressors etc.)? 
-  * If upgrading, use document “Critical Care Transfer/Accept Note”+ 
 +CALL A CODE BLUE so you can get more help/equipment right away 
 + 
 +__**Not Crashing, but Needs ICU Bed**__ 
 + 
 +Call the ICU charge nurse for a bed, and ask the floor nurse to call report 
 + 
 +Apart from ICU charge and floor RN being aware of move, we need this get a patient to ICU list: 
   * Transfer Order to bring patient into ICU census   * Transfer Order to bring patient into ICU census
-    * Enter Order “Transfer: Inpt to Inpt Unit” +    * __Primary team should enter this__, but we can be helpful if need be 
-    * Ask nursing to click the transfer order on the worklist manager.  +      * Enter Order ''Transfer: Inpt to Inpt Unit'' 
-  * Review/modify orders and medications as appropriate for ICU  +  * We write ''Critical Care Transfer/Accept Note'' 
 + 
 +__**Patient stays in place; Does NOT need ICU**__ 
 + 
 +  * If patient remains on floor, use document ''Critical Care Free Text'' to write your assessment and recs 
 + 
  
 ==== Outside Admissions ==== ==== Outside Admissions ====
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   * Allocate order to protocol, select the protocol that is listed under the ''Visit Reason'' (this is so we don’t have to select the protocol number every time we place an order)   * Allocate order to protocol, select the protocol that is listed under the ''Visit Reason'' (this is so we don’t have to select the protocol number every time we place an order)
 2) **ICU Admission Orders**: ''CCMD III - Admission Orders'' or ''CCMD III - Pediatric Admission Orders'' 2) **ICU Admission Orders**: ''CCMD III - Admission Orders'' or ''CCMD III - Pediatric Admission Orders''
 +
 +
 ====== Triage Responses ====== ====== Triage Responses ======
  
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   * Call Page operator to get in touch with Walter Reed Vascular Surgeon on-call   * Call Page operator to get in touch with Walter Reed Vascular Surgeon on-call
 +
  
 ===== Difficult Airway Response Team (DART) ===== ===== Difficult Airway Response Team (DART) =====
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   * Activated during code blue and brings you DART Cart   * Activated during code blue and brings you DART Cart
   * ENT, Anesthesia, Surgery Attending also responds if in house   * ENT, Anesthesia, Surgery Attending also responds if in house
 +
  
 ===== Brain code ===== ===== Brain code =====
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 //Ischemic / LVO//: page Suburban Stroke Team 301-896-3100  //Ischemic / LVO//: page Suburban Stroke Team 301-896-3100 
 +
  
 ===== Rapid Responses ===== ===== Rapid Responses =====
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   * be at bedside within 20 minutes   * be at bedside within 20 minutes
   * if unstable, call code BLUE   * if unstable, call code BLUE
 +
 +
 ===== Massive Transfusion Protocol (MTP) ===== ===== Massive Transfusion Protocol (MTP) =====
  
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     * after discussion with Transfusion Fellow, order blood products     * after discussion with Transfusion Fellow, order blood products
     * Consider ordering TEG (Thromboelastography, hemostasis)     * Consider ordering TEG (Thromboelastography, hemostasis)
- 
  
  
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 ===== Diagnostic Radiology ===== ===== Diagnostic Radiology =====
  
-  * CT scan: Page CT tech (17226) to request same day/STAT study, THEN put in CRIS order after you get approval with a time   +^study^method^ 
-  * MRI: Place order and call MRI Charge Tech (240-507-4676) to request same day study +| CT scan|Page CT tech (17226) to request same day/STAT study, THEN put in CRIS order after you get approval with a time | 
-  * Ultrasound: Place order and call Ultrasound Tech (301-594-8430) to request study +|MRI| Place order and call MRI Charge Tech (240-507-4676) to request same day study| 
-  * XRAY: Place order and page XRay Tech (17237) to request study +|Ultrasound | Place order and call Ultrasound Tech (301-594-8430) to request study| 
-  * After 5pm/weekends +|XRAY|Place order and page XRay Tech (17237) to request study| 
-○ Page the XRay tech for any radiology studies + 
-○ Xrays, non-contrast head CT or a non-contrast non-high-res chest CT will be done right away +__**After Hours (17:00 or weekends)**__ 
-○ Contrast CT, ultrasounds – you will need to speak to the Radiologist on-call, and the on-call tech will be called in - this may take an hour + 
 +  * For //any// radiology studies, page the XRay tech  
 +  * Xrays, non-contrast head CT or a non-contrast non-high-res chest CT will be done right away 
 +  * Contrast CT, ultrasounds: you will need to speak to the Radiologist on-call, and the on-call tech will be called in; this may take an hour  
  
 ===== ECHOs ===== ===== ECHOs =====
  
-  * Enter order and call ECHO lab (301-435-6038) to add on same day TTEs+  * For same-day TTE, enter order and call ECHO lab (301-435-6038)
   * Weekends: enter order and page tech on call   * Weekends: enter order and page tech on call
 +
  
 ===== Transfers out of ICU ===== ===== Transfers out of ICU =====
  
   * Find out from Charge RN what unit the patient can transfer to and if patient needs Telemetry   * Find out from Charge RN what unit the patient can transfer to and if patient needs Telemetry
-  * Complete the order/med reconciliation prior to transfer (d/c/modify ICU specific orders) and place transfer order: “Transfer: Inpt to Inpt Unit”  +  * Complete the order/med reconciliation prior to transfer (d/c/modify ICU specific orders) and place transfer order: ''Transfer: Inpt to Inpt Unit'' 
-  * Verbal signout is usually given to the primary/surgical teams during morning rounds EXCEPT for Urology, Solid Tumor, Lymphoma, and HIV/AIDS Malignancy - these services are also followed by the Inpatient Hospitalist team and they need to be paged to give verbal signout+  * Verbal signout is usually given to the primary/surgical teams during morning rounds EXCEPT for Urology, Solid Tumor, Lymphoma, and HIV/AIDS Malignancy; these services are also followed by the Inpatient Hospitalist team and they need to be paged to give verbal signout
   * Modify your Critical Care SOAP Note and type “Transfer Note” under Document Topic   * Modify your Critical Care SOAP Note and type “Transfer Note” under Document Topic
-  * Complete the section “Transfer/Accept note details”+  * Complete the section ''Transfer/Accept note details''
   * Cosign the receiving provider (usually the Attending or Fellow) and CCMD Attending once document is complete and if any modifications are made     * Cosign the receiving provider (usually the Attending or Fellow) and CCMD Attending once document is complete and if any modifications are made  
  
-===== Expiration ===== 
  
-  * Enter Discharge Expiration Note to generate Discharge order  +===== Patient Deaths ===== 
-  * Need Discharge Summary within 30 days - if patient has been in the ICU < 14 days, the primary team writes this. If > 14 days, ICU writes the summary + 
-  * Admissions will call you to discuss the death certificate process+  * Enter ''Discharge Expiration Note'' to generate a Discharge order 
 + 
 +__**DC Summary Writing**__ 
 + 
 +  * patient in ICU < 14 days, the primary team writes this 
 +  * patient in ICU > 14 days, ICU writes 
 + 
 +__**Death Certificates**__: Admissions will call you to discuss the death certificate process 
  
 ===== PVCS (Vascular Access Service) ===== ===== PVCS (Vascular Access Service) =====
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   * VAD (Vascular Access Device) RNs place PICC lines and ultrasound guided PIVs   * VAD (Vascular Access Device) RNs place PICC lines and ultrasound guided PIVs
   * CRIS order for PICC: VAD    * CRIS order for PICC: VAD 
-o Click on box for Consult+    * Click on box for Consult
   * CRIS order for PIV: VAD   * CRIS order for PIV: VAD
-o Click on box for Generic procedure request +    * Click on box for Generic procedure request 
-  * CCMD is responsible for reading the PICC line CXRs to check placement.  Someone from the procedure service will call you to look at the Xray and cosign you to the procedure note.  +  * CCMD is responsible for reading the PICC line CXRs to check placement.  Someone from the procedure service will call you to look at the Xray and cosign you to the procedure note.  
 + 
  
 ===== Lines ===== ===== Lines =====
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   * Central lines: policy is all lines are done with full barrier precautions and an ultrasound.  The VAD nurses are also happy to teach you how to place PICC lines- just ask if you have time.   * Central lines: policy is all lines are done with full barrier precautions and an ultrasound.  The VAD nurses are also happy to teach you how to place PICC lines- just ask if you have time.
   * CRIS note for Central and Arterial lines: Central VAD Insertion   * CRIS note for Central and Arterial lines: Central VAD Insertion
 +
 +
  
 ===== Bronchs ===== ===== Bronchs =====
  
-  * Move the patient to one of the negative pressure rooms (room 6 or 12)  +  * Move the patient to one of the negative pressure rooms (room 6 or 12) 
-  * Micro orders: CCMD IV - Procedures: Respiratory Micro (not bronchoscopy procedure)+  * Enter Micro orders: ''CCMD IV - Procedures: Respiratory Micro'' (not bronchoscopy procedure)
   * Fill in the extra information required in the cytology order   * Fill in the extra information required in the cytology order
-  * Submit your orders-or you can place orders-linked from the Bronchoscopy procedure note.  Then your note will show exactly what you ordered.   +  * Submit your orders (or you can place orders linked from the Bronchoscopy procedure note).  Then your note will show exactly what you ordered.   
-  * Stickers should print- put them on the specimen or in the bag with the appropriate specimen, make sure there are patient labels on the containers + 
-  * During daytime hours: hand deliver the specimens to the micro lab and cytology lab (tube system and transport services are not reliable for difficult to obtain specimens) +Stickers should print: put them on the specimen or in the bag with the appropriate specimen, make sure there are patient labels on the containers 
-o After 5pm: hand deliver the specimens to the micro lab and the cytology fridge located in lab+ 
 + 
 +  * Before 17:00: hand deliver the specimens to the micro lab and cytology lab (tube system and transport services are not reliable for difficult to obtain specimens) 
 +  * After 17:00: hand deliver the specimens to the micro lab and the cytology fridge located in lab 
  
 ===== CRRT ===== ===== CRRT =====
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   * CRRT Orders guide is in a folder at the back of the first computer station   * CRRT Orders guide is in a folder at the back of the first computer station
   * Call Dr. Danner (#in Fellow phone) for every patient being placed on CRRT and for any CRRT questions/concerns   * Call Dr. Danner (#in Fellow phone) for every patient being placed on CRRT and for any CRRT questions/concerns
 +
 +
  
 ===== IR aka Special Procedures ===== ===== IR aka Special Procedures =====
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   * CRIS order “SP___” and SISweb need to be placed    * CRIS order “SP___” and SISweb need to be placed 
   * Call Anesthesia if you anticipate your patient needs monitored anesthesia care   * Call Anesthesia if you anticipate your patient needs monitored anesthesia care
-○ RNs are only allowed to provide conscious sedation with IV fentanyl and midazolam +    * RNs are only allowed to provide conscious sedation with IV fentanyl and midazolam 
-○ CCMD is NOT allowed to push propofol in IR (only anesthesia)+    * CCMD is NOT allowed to push propofol in IR (only anesthesia) 
  
 ===== Misc ===== ===== Misc =====
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   * Restraints (medical/surgical – NOT behavioral health) Order and a Restraints Progress note must be completed every 24 hours    * Restraints (medical/surgical – NOT behavioral health) Order and a Restraints Progress note must be completed every 24 hours 
   * Massive Transfusion Protocol: Call Transfusion Medicine Fellow to activate   * Massive Transfusion Protocol: Call Transfusion Medicine Fellow to activate
-  * +
  
 ====== Essential Phone Numbers ====== ====== Essential Phone Numbers ======
  
-Admissions +^ Department ^ Instructions ^ 
-301-496-3141 +| Admissions | 301-496-3141 | 
- +| Anesthesia nights / weekends| 301-913-6453| 
-Anesthesia On=Call Nights after 5:30pm/Weekends +| Anesthesia call room| 301-435-8207 | 
-Ph: 301-913-6453 +| Blood Bank, Accessioning |301-496-4506| 
-Call room: 301-435-8207 +| Blood Bank, Transfusion Medicine Fellow | 240-534-9559 | 
- +| CT, front desk | 301-402-4066| 
-Blood Bank +| CT, tech pager| 17226 | 
-Accessioning: 301-496-4506 +| ECHO lab| 301-435-6038 | 
-Transfusion Medicine Fellow: 240-534-9559 +| ICU | ICU: 301-451-0567\\ICU Fellow: 301-256-5774\\NPs: Nancy: 202-560-2331; Therese: 202-413-0286; Patricia: 240-762-2663; Rashidah (Saturdays): 301-728-6023\\Nutrition (Stacie): 301-771-1209\\Respiratory Therapy: 301-913-6081 | 
- +| IR | Front desk: 301-402-0256 | 
-CT +| Laboratory | Chemistry lab: 301-496-3386| 
-CT front desk: 301-402-4066 +| Laboratory | Hematology lab: 301-402-2171| 
-CT Tech pager #: 17226 +| Laboratory | Micro lab: 301-496-4433 | 
- +| MRI,  Front desk|301-496-0026| 
-ECHO +| MRI, Tech | 240-507-4676 | 
-ECHO lab: 301-435-6038 +| OR Front desk | 301-496-5646 | 
- +| Pharmacy | Janell: 301-832-1538\\Willy: 240-762-3633\\Pharmacy Main: 301-480-6337 | 
-ICU +| Radiology | Body (all modalities): 301-832-5970\\Neuro: 240-743-8862\\Nuclear Medicine: 301-496-5675\\X-ray Tech pager: 17237 | 
-ICU: 301-451-0567 +| Ultrasound, Tech | 301-594-8430 | 
-ICU Fellow: 301-256-5774 +| VAD | 301-594-8430 | 
-NPS: +| Children's | 202-476-5000 | 
-Nancy: 202-560-2331 +| Suburban ER | 301-896-3880 | 
-Therese: 202-413-0286 +| Page Operator | For all other services, call 301-496-1211 or send pages through http://102pager.nih.gov/ |
-Patricia: 240-762-2663 +
-Rashidah (Saturdays): 301-728-6023  +
-Nutrition (Stacie): 301-771-1209 +
-Respiratory Therapy: 301-913-6081 +
- +
-IR +
-Front desk: 301-402-0256 +
- +
-Laboratory +
-Chemistry lab: 301-496-3386 +
-Hematology lab: 301-402-2171 +
-Micro lab: 301-496-4433 +
- +
-MRI +
-MRI front desk: 301-496-0026 +
-MRI Tech: 240-507-4676 +
- +
-OR  +
-Front desk: 301-496-5646 +
- +
-Pharmacy +
-Janell: 301-832-1538 +
-Willy: 240-762-3633 +
-Pharmacy Main: 301-480-6337 +
- +
-Radiology +
-Body on all modalities: 301-832-5970 +
-Neuro: 240-743-8862 +
-Nuclear med: 301-496-5675 +
-Xray Tech pager 17237 +
- +
-Ultrasound  +
-Tech: 301-594-8430 +
- +
-VAD +
-301-594-8430 +
- +
-Children’s: 202-476-5000 +
-Suburban ER: 301-896-3880 +
-*For all other services, call the page operator 301-496-1211 or send pages through http://102pager.nih.gov/ +
hospital_guides/nih.1784657954.txt.gz · Last modified: by admin

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